Monday, November 17, 2008

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.


Dr. Rob said...

This is a fine line. Clearly overmedication is a problem, but we are doctors and use medications. I believe I am helping people by giving them a medication - otherwise I wouldn't do it. The author in this piece goes so far as to mention the "natural" medications as well as saying her mother takes a multivitamin (which has not been shown to be helpful). I agree that these things need to be taken with a grain of salt - the media hype is way beyond reasonable - but an organized approach to use of medications in each patient (can you say "Medical Home?" and "EMR") is the route we need to take.

As an aside, the e-prescribing programs pushed by Medicare may fix some of this problem, as we have access to a person's prescription dispensing record.

Anonymous said...

A few observations. First, Neel's full name is provided in the article. Second, of course any clinical pharmacist would charge for intensive medication evaluation services. It's too bad that such services, when provided by licensed pharmacists, are not covered by insurance. Third, this article does not advocate that everyone should stop taking all their meds, nor that changes should be made all at once; that's a foolish misrepresentation.

Anonymous said...

You write that the article you saw was a "journalistic piece designed to have you consider stopping all of your medicines at once!"

That's just false (I agree with the previous post). Can you point to one thing in the article that backs up your assertion?

And, in the interest of full disclosure, perhaps you should have mentioned your hourly rate (or the equivalent).

Anonymous said...

I have Neel's book, Are Your Prescriptions Killing You? and it convinced me to stop omeprazole and simvastatin but I am unsure if his views are true or not. He says omeprazole can actually cause what it is supposed to cure (GERD). And he says "If you're 60 or older, my recommendation is that you stay away from statins at all costs ..." I am worried about what to do.

Dr. Matthew Mintz said...

Not everything that Dr.Neel says is ridiculous. He makes good points in his book about over-prescribing and over medicating. We need to be careful with anything we put in our body, and that includes supplements, vitamins, foods, etc.
However, any statement like stay away from statins "at all costs" is ridiculous. Statins have been proven to save lives. They do have some side effects. However, in general for people who need statins, the risk of taking the drug is far outweighed by the risk of not taking the drug.
I would talk to your doctor and discuss the risk and benefits of taking a statin.