Too many medications

19 Apr
2005

As an internist, I willingly prescribe medications. On rounds we often discuss which medications a patient is taking and which he/she should take. Often we find that the patient takes too many medications. Experts Say Americans Are Overmedicating

The problem is understandable. Over the past 30 years, we have available many more useful medications. However, each medication has pros and cons, pluses and minuses, benefits and risks. Too often patients receive prescriptions from several physicians. In these cases, the patient lacks a conductor – someone to coordinate the symphony. And patients need someone to coordinate their care.

The big mistake in the primary care promotion of the late 80s and early 90s was the use of gatekeeper as the metaphor. Conductor should replace gatekeeper. As a generalist, I should know all of my patients medications – and be responsible for minimizing the number.

Just because a patient has a problem which has a potential pharmaceutical treatment does not mean we have to prescribe that treatment. Some problems do require pharmaceuticals – because we know that their use improves morbidity and mortality.

Do we need all these drugs? A relative handful yank many people away from almost certain death, like some antibiotics and AIDS medicines. Though carrying some risk, other drugs — such as cholesterol-cutting statins — help a considerable minority dodge potential calamities like heart attack or stroke.

The right balance of risk and benefit is still harder to strike for a raft of heavily promoted drugs that treat common, persistent, daily life conditions: like anti-inflammatories, antacids, and pills for allergy, depression, shyness, premenstrual crankiness, waning sexual powers, impulsiveness in children — you name it.

“We are taking way too many drugs for dubious or exaggerated ailments,” says Dr. Marcia Angell, former editor of the New England Journal of Medicine and author of “The Truth About the Drug Companies.”

“What the drug companies are doing now is promoting drugs for long-term use to essentially healthy people. Why? Because it’s the biggest market.”

For patients – make certain that each medication has a necessary purpose. For physicians – spend some time to consider each medication – and then determine which ones you can eliminate. The patient might just feel better without the medication.

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11 Responses to Too many medications

Avatar

janice

April 19th, 2005 at 5:30 pm

Absolutely, because right now, my husband is taking over eleven meds. He is starting to suffer from loss of memory, pains and burning in his legs and hands and sometimes numbness in both. he has headaches and neck pain and on top of it all he is diabetic. I try to feed him a nutritous meal, and he still gains weight. He went off the lipitor for a few months, and the cholesterol went high on him again over 355 , so he is back on it. Now he has gained 17 pounds inthe last month and a half. Its not water weight, either. I am so dissappointed in his doctor as we never get to see him. I have seen him one time in two years. He always has a para look at him. Which I have no problem with as long as I know the doctor is giving us what we need medically too. So, yes I do agree with you about the meds. He takes blood pressure meds, zocor, proscar, and 8 others which I dont even have a clue what they are for. But they say he needs them Thank God we go to the veterans hospital for all this, otherwise we couldnt afford his meds at all. Thank you for writing such an interesting and informative article. Keep up the good work.

Avatar

Damon Mc

April 19th, 2005 at 7:58 pm

Here is the best advice for both doctors and patients, EDUCATE yourselfs on the medications that are avaliable. This could save alot of money and many lives.
We must remember that newer drugs are marketed and we do not understand them completly. These are sale reps pushing these drugs, not someone whom has taken the drug or even has a remote understanding of the treatment that the drug is intended for.
One big issue right now is the pain medication. This should be up to the patient if he or she wants to take a narcotic over a new medication that we do not fully understand or because it is believed at the time that the drug is not addictive. The truth is all medications are addictive. Vitiamins, asprin, heart pills ect…
Lets leave the drug companies and the insurance companies out of the health care that the doctor and patient should be discussing and making a stratigic plan for ones health.
My body is my body and I should have a say in what I put into my body. And the doctor should be able to give his advice, but there should be some sort of educated compromise.

Avatar

marie

April 19th, 2005 at 8:37 pm

I am a RN, a Case Manager with years of experience in Nursing. This year, my 55th, I have been given 2 meds that I discontinued myself for horrible side effects. Topomax made me have severe mental confusion and Actos made me gain several pounds and caused sever edema in legs. Common sense told me to quit both drugs intended to keep me painfree and from becoming diabetic. I think a better solution for me is to rest more and watch my diet instead. The quick fix did not work so back to the drawing board. The real plus is I will save so much money on co-pays…..I have more understanding of what my clients are going through trying to decide if their meds are what is making them sick.

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profderien

April 26th, 2005 at 7:43 pm

I was very glad to see this topic taken up. Let me add my anecdote to the jolly mix — call it a lesson in side effects, or “here-we-go-round-the-mulberry-bush”:

daily doses of prednisone as part of treatment for lupus; bone fractures begin, doctors hem and haw as to why; by the time said doctors ‘fess up about the down side of prednisone, three major joints “gone” due to severe osteonecrosis; crash and burn, hypoglycemic, hypotension galore — addisonian crises.

what is the treatment for adrenal insufficiency?

you got it: steroids…

(by the way, i am having my third major joint replacement, the right shoulder, next thursday — think good thoughts! the last time, for the left shoulder, they *forgot* the stress dose steroids… can you say “coma”?)

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neko_san

April 26th, 2005 at 11:24 pm

*warning: prickliness ahead*

Ah yes, good old “normal daily life” conditions like depression, where you sit huddled in a corner, unmoving except for when you tear at your flesh with your fingernails and teeth, trying to ignore the symphony of evil voices that you’ve given up on trying to make go away, losing 5 pounds per week because all food is vile.

I count myself extraordinarily lucky that the combo of 4 psych meds I’m on has gotten me from “severe clinical depression” to “moderate clinical depression”. Even though i don’t *like* taking all of them, it’s a hell of a lot better than the alternative.

Avatar

neko_san

April 27th, 2005 at 1:53 pm

snarky addendum:

…because everybody knows that, unlike “real” diseases like pneumonia, depression is merely a dubious aliment, and antidepressants never save people from killing themselves. *rolls eyes*

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roxanne darling

February 2nd, 2006 at 10:13 pm

Hello, I am not sure if you answer questions…but my parents (early 80s, active, but have dealt with cancer, hypertension, arthritis) area each taking many prescriptions, and having side effects IMO. I trust their internist to give a fair assessment of whether there are conflicts and/or alternatives. Any ideas how I would go about finding a credible medical professional who could consult on this topic?

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amy

July 11th, 2008 at 4:21 am

i was suicidal, so was put on effexor, then showed anxiety as well as depression, so was put on largactil and tamazapan and valium, i also have bpd traits so have now been put on epilim.
i feel like i am taking too many meds:
300mg effexor, 5-10mg valium, 75mg largactil, 20mg tamazepan, 1.2g epilim.
i think its getting a bit rediculous. i was better on no meds than the constant mixture of all of these. and all prescribed by the same psych ive had for 6months. what should i do?

Avatar

Bill Vowels

May 9th, 2009 at 12:00 am

MY WIFE HAS SO MANY HEALTH PROBLEMS.IT SEEMS LIKE SHE IS TAKING TOO
MUCH MEDS. I HAVE TWO JOBS AND SO MANY BILLS. HER MEDS IS SO HARD TO
DEAL WITH. I FEAR THAT TOO MUCH MEDS MIGHT BE DOING HER MORE HARM
THAT GOOD.SHE HAS ABOUT 20+ MEDS A DAY.WHAT CAN WE DO?

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Bill Vowels

May 9th, 2009 at 6:59 am

please help us,if you can

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TinaMarina

January 16th, 2010 at 3:52 am

My Sister is on 17 different medications. I don't understand what they're all for or why a doctor would allow her to take so many medicatins at one time. My sister is only 32 years old and I feel like all the medications are killing her. She can't even get out of the bed and take care of her children most days.. She checks into her "Day Spa" when she wants to check out of her reality. Her "Day Spa" is a Mental Hospital and when she's there she's the smartest and best dressed crazy person I have ever met. Do I think she is crazy?? No!!! She checks in for a couple of days then goes home when she is ready then in a couple of weeks she goes right back. I think she has a pill problem. Please help. How do we get these doctors to stop giving these people so many medications. My sisters husband doesnt tell the family  the truth about about anything. He doesnt understand that by not standing up to her and by not telling the doctors what she is doing he is helping kill her..

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