Your Medicines Are Killing You

MSNBC just posted a piece called "Is Your Parent Over-Medicated?" This is one of many articles in the media designed to have us think that the medicines our physicians prescribe are, in general, harmful and more likely to hurt us then help us. I have blogged about this before ( The truth on the 8 drugs doctors wouldn't take). This piece, which discusses the author's concerns that her mom's memory problems were related to taking too many medications, is actually a re-print from Prevention Magazine.

There is no question that polypharmcy, or taking a whole lot of medicines, can be a major problem and is likely an issue for many Americans. This can be specifically a problem for elderly patients who metabolize medications differently, are more susceptible to side effects, and are more likely to see multiple physicians prescribing different medications.

However, a few critical points about a journalistic piece designed to have you consider stopping all of your medicines at once!. First, Neel, the pharmacist the author consulted with who no other name is given (not clear if Neel is the first or last name, or he such a famous pharmacist that he goes by only one name like Madonna or Cher) and only described as the "Georgia consultant pharmacist" is actually Armon Neel, Jr., PharmD, CGP, FASCP who has started a business of consultant pharmacists called Medication Xpert. Dr. Neel is certainly highly qualified. After looking at several of his detailed sample consultations on the web site, it seems like many of the recommendations of stopping medications are replaced by either stronger recommendations for diet and exercise and/or substitutions with vitamins and supplements. This is something I am sure Prevention Magazine (also very anti-medication) likes a lot.

The problem is that there is limited data (with the exception of the DASH diet) for diet and exercise as a potential replacement for medications to control chronic diseases such as high cholesterol, hypertension and diabetes. This is not to say that diet and exercise is not important. On the contrary, it is the cornerstone of management of many chronic medical conditions. However, once the disease is established, it is very hard for diet and exercise changes to eliminate the need for medications. In addition, vitamins and supplements have problems of their own. Some supplement may not be safe, and even common vitamins like C and E may actually be harmful (see here).

The bigger issue of polypharmacy is not that medications are killing you, its that we are not looking closely enough at potential redundancy and interactions with medications. We currently have a discoordinated health care system with no single source of patient medical information. For the elderly patient who is seeing multiple specialists, those doctors rely on the patient's history of what medications he or she is or is not taking. A shared electronic medical record (EMR) would keep patients and physicians up to date and could automatically warn of potential interactions, but this will cost a lot of money. However, even if an EMR were available and ubiquitous, this alone would not be enough. It takes time to talk to patients about their medications and side effects. In the article, the author's mother was give four asthma medicines for a cough that was not asthma but a side effect of another medication. A few extra minutes by a primary physician and some simple office based testing could have picked up the problem. However, we have heard many times how primary care physicians are struggling.

One should note that Dr. Neel is not just a friendly, knowledge pharmacist at your local CVS. Dr. Neel is a consultant. He charges a retainer fee of $300.00 per year and $115.00 per hour. Now we have concierge pharmacists to go along with our concierge physicians. Siri Carpenter, the author of this piece forgot to mention this small fact.