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Show 1185: What Are the Risks of Too Many Meds?

Lots of Americans, especially senior citizens, are taking too many meds. This can result in undesirable reactions and dangerous interactions. Can we fix it?
Cynthia Boyd, MD, Professor of Medicine, Johns Hopkins University School of Medicine
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What Are the Risks of Too Many Meds?

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Every day, an average of 750 senior Americans are hospitalized as a result of medication reactions and interactions. Part of the problem is that as we grow older and accumulate more health conditions, we also end up with longer lists of prescription drugs for them. In addition, many of us also take medicines to prevent problems, such as statins to lower our cholesterol and reduce the risk of heart disease. Are you taking too many meds?

How Following Guidelines Can Lead to Too Many Meds:

Clinical guidelines are designed to help standardize medical practice and make sure that all patients are getting appropriate treatment. However, in a time-pressured practice setting, some guidelines may end up being used as a way to evaluate doctors’ performance. They were not developed for this purpose, and as a result, patients might end up taking too many meds that aren’t essential for them so that the practitioner can “check the box.” Are all of your prescriptions for drugs that you actually need? How can you find out? Moreover, if you don’t need them all, what should you do about it? 

The Prescribing Cascade:

Frequently, a patient sees a health care provider with a specific complaint. Ideally, the provider makes a diagnosis and prescribes the most appropriate treatment. Sometimes, however, even an appropriate medicine can cause side effects. The patient returns to report these new symptoms. Here is where it gets tricky. The health care professional may recognize them as reactions to the initial prescription and change the prescription. But too often, they may simply prescribe a new medicine to treat the symptoms caused by the first drug. If that medicine in its turn causes side effects, they too may be treated with an additional prescription. Before long, the patient can end up with too many meds. Can we short-circuit this process?

Doctors Should Be Empowered to Deprescribe:

Frequently, a primary care physician may be reluctant to discontinue a medicine initially prescribed by a specialist. What if the patient still needs it? Will PCPs get in trouble if they deprescribe medications? In addition, some drugs require specialized protocols for discontinuation so that the patient can stop taking them without suffering unpleasant or even unbearable withdrawal symptoms. How knowledgeable does the doctor feel about this procedure?

The Culture of a Pill for Every Ill Encourages Too Many Meds:

Over the last half-century or so, American culture has changed from one that emphasized self-reliance to one that envisions a pill for every ill. The plethora of drug ads on television all imply that anything that might be bothering you could be fixed with the right medication. No wonder people are so willing to take a fistful of pills, and doctors are so eager to prescribe them! How can we alter our culture to support deprescribing and encourage physicians to pare prescriptions to the minimum necessary? That way older Americans–and the rest of us–will be less likely to take too many meds.

This Week’s Guests:

Shannon Brownlee is Senior Vice President of the Lown Institute, a non-partisan public policy think tank based in Boston. She is also Co-Founder of the Right Care Alliance, a grassroots organizing network of patients, clinicians, and community leaders advocating for a radically better health care system. Her groundbreaking book is Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. The New York Times named it the best economics book of 2007. The Lown Institute report is “Medication Overload: How the Drive to Prescribe Is Harming Older Americans.

Shannon Brownlee, Senior Vie President of the Lown Institute, author of Overtreated

Cynthia Boyd, MD, MPH is a professor of medicine at the Johns Hopkins University School of Medicine. She holds a joint appointment in health policy and management and epidemiology at the Johns Hopkins Bloomberg School of Public Health. Dr. Boyd is a core faculty member at the Johns Hopkins Center on Aging and Health, the Center for Transformative Geriatric Research and the Roger C. Lipitz Center for Integrated Health Care.

Cynthia Boyd, MD, Professor of Medicine, Johns Hopkins University School of Medicine

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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It seems the best course a patient can take is to ask lots of questions, insist on answers, data (such as NNT–number needed to treat and NNH–number needed to harm), absolute risk reductions, known drug interactions, and above all, “How can we work together so I can avoid medications altogether, or at least eliminate all but the absolutely proven essentials?” It might also help patients to insist that the only certainty in their life is that it will end. And that they don’t want to spend the last few years of their lifespan in a drug-induced fog or in a state of incurable frailty. The dangers of long-term use of certain medications might be more harmful for quality of life.

Regular physical exercise is one of the best, proven medicines anyone can take. It doesn’t cost a thing (nor does it provide Big Pharma with revenue) and can help take care of all sorts of problems. Oh, and it helps you feel better and sleep better, too.

As far as legislation is concerned, wouldn’t it be nice to see direct-to-consumer advertising of prescription drugs banned, like it is almost everywhere else in the world?

I don’t have time to listen to a podcast; I read your newsletter to get answers.

I listened to a portion of this program this morning, and the guest stated that there was a problem with medical record software. They described a situation where a person’s dermatologist might prescribe one medication, and then the person’s cardiologist might prescribe another one that may interact negatively with the one prescribed by the other doctor, not knowing it was being taken by the patient. She said only by bringing a brown bag of all their meds to every visit could this problem be circumvented. I use Epic’s MyChart, as do all of my providers, and they all see all my meds.

The snowball effect of adding one prescription on top of another does lead to some horror stories. As we age our biological systems change, and processes often slow down or become less efficient. For example, for 5 years my wife took a diuretic with no problem, and then like a bolt out of the blue she experienced a dangerous bout of hives. The ER doctor identified the cause right away, and the medication was immediately changed. There had been no recent changes with regard to diet or other medications so it was easy to point to the diuretic as the suspect cause. I’m glad to report that she’s had no additional attacks of hives since on new diuretic.

I surmise that, due to aging process,the side affect became more pronounced, producing the hives. Lesson we both learned is not to be complacent but remain alert to any unusual changes that may be early signs of impending trouble. Had we brushed off the early symptoms, my wife of 46 yrs might not be with me.

Question we have: Your thoughts concerning drug holidays or short-term reduction in medication strength level, i.e., Amlodipine Besylate, 5 mg taken once per day. Might 2.5 mg taken twice a day 12 hours apart be much better at maintaining a stable amount in blood stream. My own thoughts are that BP varies in normal persons with safe level of pressure so might it be worth looking into treating patients to produce similar results? The draw back is it complicates dosing requirements, and some patients may get confused and miss or take double the recommended dose. I think you get where I am going with this. Thanks for keeping us informed. You both are wonderful.

My brother-in-law, who is seventy three, is an insulin diabetic and has been for years. I have watched him go down hill for the last three years. He is taking FIFTEEN medications every day. He will lose his balance and almost fall now, falls asleep instantly before he even sits down, is not remembering things that happen within a couple hours of the event, and is having anger issues. This week the doctor did blood work on him, and my sister was told that the results did not look good. I have encouraged her to ask about all these medications he is taking and whether they are really needed!

I am seventy four and I only take two prescriptions: one a beta blocker (Afib) and one an estrogen inhibitor (breast cancer). If I agreed I would also be taking one for high cholesterol, a blood thinner, and one to build up my bones. No thank you to many side effects! I also refused chemo and radiation when I had breast cancer seven years ago. This is your body, and you need to make decisions that will be good for you despite what a doctor says.

I have to wonder about where to start. With the seventeen medications we are using I have had to revert to our specialists recomendations about what drugs interfere with our principal ailment concerns. I had been excited about statens after my adventure with Chinese red yeast rice. For me my goal now it is celery and peanut butter rather than coffee cake in the afternoon. And more exercise.

I wonder how many meds seniors would request if not covered by Medicare. For the most part good is medicine with fewer side effects,

Years ago I had a 78 year old patient who asked her doctor to help her get off so many drugs. To his credit he did just that. She went from 12 to two. She said the drugs made her “nuttier than a drunk peach orchard bee.” She reported she felt better than she had in years and is still living well into her ninties.

Being 74 myself my doctors keep trying to put me on this and that. I have always tried to find an alternative natural remedy and to this day take no prescription medications even though I have had over a dozen recommended. I take care not be foolish and would certainly take anything needed to support life. Very few fall into this catagory.

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