Too much of a good thing can be a bad thing, especially when it comes to prescription drugs. Advances in pharmacology have brought huge benefits in treating and preventing disease and in extending life, but when used improperly or to excess, medications can result in more harm than good.
Research has shown that polypharmacy — the prescribing of multiple medications for one patient, especially seniors — can be harmful. However, the Therapeutics Initiative, a group that provides independent assessments on the safety and effectiveness of pharmaceuticals, has collected statistics that show B.C. doctors continue to prescribe multiple medications to seniors.
The study by the University of B.C.-based group shows that four per cent of British Columbians aged 85 or older have been prescribed 10 or more drugs at once; 31 per cent have been prescribed at least five drugs.
Dr. Rita McCracken, a residential-care physician and associate head of the department of family practice for Providence Health Care in Vancouver, said physicians have been bombarded with reminders about the risks of polypharmacy, “and many of us feel we’ve adapted to this and made changes. The stark realization is we have not even begun to stem the tide of the prescribing wave. Even though sensitivity is being raised, we are still overprescribing.”
The profusion of medications poses risks — one medication might conflict with another, some medications might have adverse reactions and some drugs might not be in the best interests of the patient.
For example, if an elderly person is suffering from aggressive cancer and would prefer to die in her sleep, it doesn’t make sense to prescribe a drug intended to prevent sudden cardiac arrest.
Some drugs have severe side-effects that might not be worth the therapeutic effects of the drugs.
For instance, a study published recently in the British Medical Journal shows that thousands of Canadians with only mildly high blood pressure are being put on drugs that increase the risk of falls and hip fractures, yet have no proven benefits.
Untreated hypertension (high blood pressure) is considered to be responsible for up to half of deaths from heart disease and stroke, so treating the condition is important, yet the Canadian-led study, involving nearly 9,000 patients with mildly high blood pressure, found those given drugs for the condition were no less likely to develop or die of coronary heart disease or stroke than patients given a placebo. And of those who took medication, nine per cent suffered side-effects including dizziness and disease.
And yet another study, this one from the U.S., finds many nursing-home patients who suffer severe dementia and are likely to die within a year or two are administered medications that offer little to no benefit. In fact, the drugs often cause pointless discomfort.
The Therapeutics Initiative study says “exuberant prescribing” is driven by an aging population, but also by aggressive marketing. The “ask your doctor” kind of pharmaceutical advertising influences people to put pressure on their doctors to prescribe a certain kind of medication, and some physicians are also swayed by the industry’s marketing.
The TI report also points to chronic-disease treatment guidelines that don’t take into account the complexities of treating several different ailments at the same time. It recommends doctors seek to reduce the number of drugs a person takes.
When antibiotics were first developed, they were known as “miracle drugs” for their effectiveness in treating infections, and so we have come to expect miracles from all our medicines.
But we should shy away from expecting that there’s a pill for everything, and that if one drug is good, more is better. Sometimes more is worse.
