Drug-based, symptom-focused health care is contributing to an epidemic of overprescription.
Researchers published some shocking statistics about the dramatic rise in adverse drug reactions in the UK in a study published in BMJ Open in July. Many of these adverse reactions were related to the number of prescriptions prescribed to the study participants.
“Polypharmacy,” the term for prescribing multiple drugs, is at the heart of an epidemic of overprescription. The issue has been snowballing in the past decade as big pharma continues to develop new drugs. To truly achieve better health, patients need to be advised and supported to make lifestyle changes that support health. That’s because most of the chronic conditions that people are being treated for arising directly out of factors ranging from a poor diet and lack of exercise to habits such as smoking and drinking. In the case of immediate need, drugs can provide a stop-gap measure, but true healing requires addressing the root causes of the illness. Unfortunately, this rarely happens. Instead, health care providers simply prescribe drugs for a condition—sometimes with multiple prescriptions.
When a patient ends up taking multiple prescriptions, it’s called polypharmacy, a term that is used often but with varied definitions. According to one article, the term polypharmacy “was used over one and a half centuries ago to refer to issues related to multiple-drug consumption and excessive use of drugs.”
No matter when the term originated, it’s commonly accepted that polypharmacy is the prescription of too many medications. According to the Centers for Disease Control and Prevention (CDC), “Polypharmacy, often defined as the simultaneous use of five or more prescription drugs, is more common in an aging population where multiple coexisting chronic conditions often occur.”
The use of multiple prescriptions is almost always to treat several chronic conditions at the same time. Yet this causes side effects, can trigger additional health concerns, and can even lead to death. The results from the featured study demonstrate the depth of the need for deprescribing to affect a real change in people’s health.
Polypharmacy Driving Adverse Drug Reactions
The data for the BMJ Open study came from two physicians who did chart reviews of hospitalized patients over a one-month period. This prospective observational study was published by researchers at the University of Liverpool and Bangor University. They reviewed data from 1,187 patient charts admitted to Liverpool University Hospitals.
The results were an update of the original study published in 2004, which shows that 6.5 percent of hospital admissions were the result of an adverse drug reaction. In the current study, the reviewers recorded the number of admissions that were due to an adverse drug reaction when patients stayed for more than 24 hours. The outcome measures were mortality, multimorbidity, and polypharmacy.
The study also estimated the projected cost to the National Health Service (NHS) in England. The reviewers identified 218 admissions triggered by an adverse drug event, which indicated an 18.4 percent prevalence. Of these, 90.4 percent of the admissions were a direct result of an adverse event.
In this group, the researchers found that, on average, patients with an adverse event were taking more medications and had more comorbidities than those who didn’t have an adverse drug reaction. On average, those with an adverse drug reaction were taking 10.5 drugs versus those without a drug reaction who were taking 7.8 medications.
The drugs that were more commonly found to produce drug reactions associated with hospitalization included steroid inhalers, proton pump inhibitors, antihypertensives, anticoagulants and antiplatelets, diuretics, and chemotherapeutic agents. Of the 218 patients admitted for treatment of an adverse drug reaction, the physician reviewers believed that 40.4 percent were avoidable or possibly avoidable. The average length of stay for these patients was six days.
The researchers believe these events place “a significant burden on patients and healthcare services with associated financial implications.” They concluded that “reducing inappropriate polypharmacy should be a major aim” to prevent adverse events.
“Our work suggests adverse drug reactions place a significant burden on patients and hospital admissions. This has a large associated cost to the NHS (over £2 billion per year [$2.45 billion]) and further efforts in this area could both improve patient care and save money for the NHS,” Rostam Osanlou, a specialist registrar in clinical pharmacology, said in an article the University of Liverpool published on Science Daily.
America’s Other Drug Problem
Health Affairs calls overprescribing and polypharmacy “America’s other drug problem.” According to the CDC, 45.8 percent of the people surveyed from 2015 to 2016 claimed that they used one or more prescription drugs in the past 30 days. The CDC recorded a similar number in the time span from 2015 to 2018 when 48.6 percent said they used at least one prescription drug in the past 30 days.
This percentage dropped to 24 percent for those who used three or more prescription drugs and 12.8 percent for those who used five or more prescription drugs. However, a report from the Lown Institute released in April 2019 shows that polypharmacy has reached epidemic proportions in the United States. According to their data:
- 5 million older adults saw their doctor or were hospitalized for drug reactions in 2018
- 42 percent of older adults take five or more prescription medications
- there was a 200 percent rise in polypharmacy over a 20-year period
- $62 billion was spent on unnecessary hospitalizations over 10 years
- estimates are that there will be 150,000 premature deaths in 10 years as a result of adverse drug events
These numbers have a staggering impact on patients, especially in light of how drugs may also adversely react with the COVID-19 vaccines and the resulting spike in protein production in the body. Unfortunately, while medication overprescribing has caused widespread harm, it remains nearly invisible to many public health leaders, clinicians, and policymakers.
Age is also a contributing factor. In 2017, a U.S. Pharmacist wrote that people older than the age of 65 made up 13 percent of the population but used 30 percent of all prescribed medications. By their definition, polypharmacy is only problematic “when the reason for the medication is unclear, when medication is taken to treat side effects of other drugs, when dosing and timing are complicated, and when medications interact with each other.”
Data from the United States show that the most common multidrug combinations are to treat metabolic syndrome. In 2019, data showed that 83.6 percent of adults aged 60 to 79 used one or more prescriptions as compared to 59.5 percent of those aged 40 to 59. In August 2021, the National Institute on Aging wrote that they were grappling with the problem of treating people with multiple chronic conditions and still trying to determine the best approach for treatment and improving quality of life.
One study published in August 2021 proposed an expanded role for pharmacists in “medication therapy management and safety monitoring” based on their data that showed polypharmacy in 65.1 percent of the population using data from the CDC’s National Ambulatory Medical Care Survey from 2009 to 2016.
Children Aren’t Immune From Overprescribing
While many of the elderly are taking multiple medications, the effects can be felt as far back as before babies are born. One study published in The BMJ in 2013 found that exposure to selective serotonin reuptake inhibitors and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) in utero increased a child’s “risk of autism spectrum disorders, particularly without intellectual disability.”
In 2014, The New York Times reported that data from the CDC showed that 10,000 toddlers between the ages of 2 and 3 years old were medicated for attention deficit hyperactivity disorder (ADHD). The medication was given outside established guidelines for the pediatric population.
While these numbers are significant, they’re dwarfed by 2014 data from the Citizens Commission on Human Rights, which showed in 2014 that hundreds of thousands of toddlers were prescribed psychiatric drugs and that more than 274,000 children from birth to 1 year old were included in that mix. According to their figures, the numbers of children aged birth to 1 year old on these types of medications were:
- 249,669 on antianxiety drugs (such as Xanax, Klonopin, and Ativan)
- 26,406 on antidepressants (such as Prozac, Zoloft, and Paxil)
- 1,422 on ADHD drugs (such as Ritalin, Adderall, and Concerta)
- 654 on antipsychotics (such as Risperdal, Seroquel, and Zyprexa)
In the 2- to 3-year-old age group, the commission found 318,997 were on antianxiety drugs; 46,102 were on antidepressants; and 3,760 were on antipsychotics.
“The above are stunning data and, yet, the most egregious element of the ever-increasing number of America’s children being prescribed psychiatric drugs, is that the diagnosis needed in order to have the drugs prescribed, is subjective,” the commission said in a statement.
Early Medicine Focused on Eugenics
The history of pharmaceutical intervention and polypharmacy dates back to the start of “modern medicine” and the “father” of it all—Abraham Flexner, who was a schoolteacher and educational theorist from Louisville, Kentucky. The 1910 Flexner Report shaped the development of medical schools and effectively eliminated any practice that the current science or medical community couldn’t explain. This included most traditional medicine practices.
The report was issued by the Carnegie Foundation at a time when there were 155 medical schools in the United States. Flexner visited them all in cooperation with leading members of the American Medical Association. The report was written to establish guidelines that sanctioned orthodox schools and condemned homeopathic medical schools.
For example, during the 1849 cholera epidemic in Cincinnati, homeopaths were so successful that they published a list of those who were cured and those who died. Only 3 percent of their patient population died while between 48 percent to 60 percent of those under orthodox medical treatment died.
After successfully using the Flexner Report to remove traditional medicine practices from medical schools, John D. Rockefeller secured a monopoly using a smear campaign to discredit and demonize homeopathy and natural medicine. Doctors were jailed and some lost their licenses for using treatments that had been effective for decades. Students were taught a system of medicine that was defined by a process of prescribing drugs.
Six years before the Carnegie Institution released the Flexner Report and forced changes on medical schools throughout the country, they opened the Station for Experimental Evolution (SEE) in Cold Spring Harbor, New York. The purpose was to study heredity and evolution, as it fine-tuned the research focus on eugenics.
According to the current definition by the National Institutes of Health, “Eugenics is an immoral and pseudoscientific theory that claims it is possible to perfect people and groups through genetics.”
While the company claims that it closed down its eugenics research operation, the SEE eventually merged to become the Cold Spring Harbor Laboratory, with a focus on the emergence of molecular genetics and the “scientific foundation of the revolution in biology and biotechnology.”
Corporate Interests Push Pharmaceutical Intervention
In 2005, an informal survey by National Public Radio found that many medical schools were relying on funding from pharmaceutical companies and other health industries. When pharmaceutical companies weren’t happy with the faculty’s behavior, they could threaten to cut off that funding. By 2018, pharmaceutical companies were actively and openly seeking partnerships with medical schools and universities.
The creation of big pharma began after the release of the Flexner Report, when Rockefeller and the Carnegie Foundation came to realize the power behind monopolizing medicine and funneling treatment modalities away from the source or cause of the health condition to focus solely on symptoms—by pushing pills to alleviate a symptom.
According to the Commonwealth Fund, the country that birthed modern medicine—none other than the United States—also spends more per capita on prescription drugs than any other high-income country.
Signs You May Be Overprescribed
Patients pay the high cost of polypharmacy in dollars and in quality of life. These signals may show that you’re being overprescribed medication:
You visit multiple doctors. You might think that with electronic medical records each of the specialists you visit knows the medications you’re taking, but that doesn’t happen. You may be prescribed one drug by doctor A and a second by doctor B to lessen the side effects of the first.
You develop a new health condition. Sometimes these conditions are the result of drug interactions or an adverse drug reaction that goes unrecognized. This can include physical and mental symptoms, such as problems with balance or motor skills, fatigue, anxiety, or unexpected weight gain or loss.
You’re in a high-risk group. People with higher risk have multiple health conditions and are older than 65 years.
You have access to good health care. It’s not uncommon for people with good insurance to see multiple doctors who are unaware of all their prescription medications.
You have trouble keeping up with drug doses. When you’re taking too many medications, it’s difficult to remember the dosing schedule.
Reducing Your Medication Load
Review this list with your primary care provider at least once per year and before you’re discharged from a hospital or rehabilitation facility.
While you might think this would be standard practice, it isn’t. In a commentary on Medscape, Dr. Mark Williams wrote of his patient “Allison,” who was admitted to the hospital for altered mental status, likely related to polypharmacy, and discharged to long-term care with “43 prescription medications and an almost equal number of over-the-counter (OTC) drugs.”
Consider creating a chart with a list of the drugs that you’re taking, who prescribed them and when, why you’re taking them, and any side effects from the medication that you may be experiencing. It’s also important to use one pharmacy for all your prescription medications. The pharmacist can quickly determine if there are any expected drug interactions between medications that you may be prescribed by several doctors.
Each time a new medication is prescribed, take care to read the insert and check online resources for expected side effects. The bottom line is that you may not need all the medications you’ve been prescribed to manage your health conditions.
Overprescribing sets up older adults for a downward spiral of increasing side effects and worsening health. A holistic approach is needed to address the key tenets of good health and create real wellness instead of attempting to cover up symptoms with more pills.
Sources and References:
- 1 BMJ Open, 2022;12(e055551)
- 2 BMC Geriatrics, 2017;17:230
- 3 Polypharmacy, July 29, 2021
- 4 Centers for Disease Control and Prevention, August 2019; Key Findings
- 5, 7, 8, 9 BMJ Open, 2022;12(e055551) Participants, Main Outcome Measures
- 6, 10 Science Daily, July 7, 2022
- 11, 14 Health Affairs, May 20, 2019
- 12 NCHS Data Brief, 2019;334
- 13 Centers for Disease Control and Prevention, Therapeutic Drug Use
- 15 Lown Institute, Medication Overload in Older Americans
- 16, 17 US Pharmacist, June 16, 2017
- 18 Scientific Data, 2017; 4
- 19 Centers for Disease Control and Prevention, August 2019
- 20 National Institutes on Aging, August 24, 2021
- 21 PLOS|One, 2021; doi.org/10.1371/journal.pone.0255642
- 22 The BMJ, 2013;346
- 23 The BMJ, 2013;346 Abstract/Conclusions grey box
- 24 The New York Times, May 16, 2014, para 1,2
- 25, 26 PRWeb, May 21, 2014
- 27, 29, 30 Homeopathy Family Medicine, A Condensed History of Homeopathy, The Fall of Homeopathy
- 28 Cancer Tutor, April 8, 2020
- 31 Homeopathy Family Medicine, A Condensed History of Homeopathy, The Rise of Homeopathy
- 32 Defend Democracy Press, October 20, 2015
- 33 Cold Spring Harbor Laboratory, Carnegie Institute of Washington
- 34 NIH, Eugenics: It’s Origin and Development
- 35 NPR, June 9, 2005
- 36 The Vaccine Reaction, April 15, 2018
- 37 Commonwealth Fund, October 5, 2017
- 38 Health Thoroughfare, May 9, 2022
- 39 Medscape, November 17, 2021
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