Polypharmacy: Is It Truly Beneficent?

I recently received the following poem from
a physician with no particular attribution:

SPECIAL POEM FOR SENIOR CITIZENS



A row of bottles on my shelf



Caused me to analyze myself.



One yellow pill I have to pop



Goes to my heart so it won't stop.



A little white one that I take



Goes to my hands so they won't shake.



The blue ones that I use a lot



Tell me I'm happy when I'm not.



The purple pill goes to my brain



and tells me that I have no pain.



The capsules tell me not to wheeze



Or cough or choke or even sneeze.



The red ones, smallest of them all



Go to my blood so I won't fall.



The orange ones, very big and bright



Prevent my leg cramps in the night.



Such an array of brilliant pills



Helping to cure all kinds of ills.



But what I'd really like to know...........



Is what tells each one where to go!





To me, “where they go” is not the issue with the prescription of and the daily use of multiple different medications (polypharmacy). To me, the issue is whether the medical practice of polypharmacy is a truly beneficent practice both to the individual patient but also to society. The goal of the physician prescribing a medication is that of providing a therapeutic benefit to the patient. The benefit should not be looked upon simply as the value of each drug to relieve a specific disease or symptom. Consideration of the benefit should include whether the drug is contributing to the total health benefit to the patient. Physicians and patients should keep in mind that the effect of one drug on the total health benefit is dependant not only it’s direct effect on the condition for which it was prescribed but whether the drug itself has harmful or detrimental potentials such as side-effects, toxicities or harmful interactions between the prescribed drug and the other medications that the patient is already taking. Benefit should also be measured by whether the addition of another drug with its own schedule for administration will disrupt the patient’s compliance with the taking of the other medications. Will the shape and color of the new pill be confused with other pills the patient, especially the elderly, is taking? Benefit should not only be measured by the parameters noted above but also whether the net wanted results of prescribing and taking a drug are sufficient to trump the drug’s expense to the patient and the healthcare system. Drugs that are very expensive might either not be purchased by the patient or the patient may discontinue or reduce the prescribed dosage of other drugs in order to afford the new one.

If the physician fails to include in the history of the patient identification of the medications already being taken and not consider the potential interactions with the new drug or the potential disruption of the dosing schedules or the costs, the physician is not performing a service. There is also the need for the physician at the outset to be confident that the patient truly needs an additional drug added to the list of drugs already being taken. Are there indications based on the patient’s symptoms, disease or lab tests that require instituting a new medication? Or is the medication being prescribed either out of a unsupported assumption, out of patient demand or out of a desire to relieve the patient’s concern that by, the conclusion of the office visit, something is accomplished. And that “something” is a prescription.

Finally, I would like to make a comment that ties into the previous thread on the media an medical practice. I think that direct-to-consumer advertising should be discontinued and there should be further ethical restrictions on direct-to-physician advertising. I don’t think any of this should represent a limitation to ordinary free speech. I think that such advertising is education slanted away from education of unbiased evidence-based pharmacology and is directed to the pharmaceutical companies own pocketbook and shareholders. These directed advertising practices, I think, inappropriately influence the public to unwarranted use of the advertised drugs for their own symptoms or illness concerns and encourages physicians to inappropriately add another drug, perhaps one that has not yet been fully tested over time, to their patient’s “row of bottles on the shelf.” ..Maurice.

(By the way, how many pills do you take?)