What Do Any of Us Know About Polypharmacy – Should We Know More?

Medical science has made tremendous strides since Antonie van Leeuwenhoek developed microscopy and revealed the world of microbes. From that day forward, the leaps and bounds led to the development of medications specifically aimed at thwarting disease in its most minute forms of bacteria. Since then, and with the additional breakthroughs in understanding pathology, the field of pharmacology has exploded, and patients are at the forefront of requesting more.

How many prescription or over-the-counter medications do you currently take? Go ahead, look in the medicine cabinet, your nightstand, or wherever else you may keep medications. I’ll wait. And please don’t forget supplements and aspirin.

According to a report from the Health Policy Institute of Georgetown University, “more than 131 million people — 66% of all adults in the United States — use prescription drugs. Utilization is particularly high for older people and those with chronic conditions.” The percentage may be higher now because the report is a few years old.

What is the annual cost of prescription drugs currently? Up until 1998, it was $73 billion yearly. With the rising increase of direct-to-consumer advertising on television, we can imagine that the number has increased substantially because consumers are now being told to “ask your doctor” for these new and usually expensive medications.

A note is necessary here. Expensive or doesn’t necessarily mean more effective, nor does it mean medications without serious and sometimes fatal side effects. And saying “more hospitals use…” than another med may only mean they get a price break.

But if you are an individual with a chronic condition, it would not be unusual for you to receive more than one drug to take at a time. Individuals with medical conditions such as diabetes are naturally seeking products that will relieve them of the need to self-inject daily. But we also know that individuals with diabetes may have several accompanying medical conditions that the disease brings with it. For these additional medical conditions, patients with diabetes may need medications for many illnesses such as in their eyes, their heart, and other organ systems of their bodies.

The Health Policy Institute also indicated that “three-quarters of those age 52–64 use prescription drugs compared to 91% of those 80 and older. The need for prescription drugs increases with age, and older adults may take up to 22 medications.” Herein lies another of the unsolved medical mysteries; what does taking that many medications do to someone’s body, and is it safe? Yes, I’m also referring to prescription medications.

Not only do older adults take many more medications (how many are treated by geriatric specialists?), but they pay much more for their medications, especially if their expenditures are out-of-pocket ones. And we know that since the FDA approved DTC, there has been an appreciative increase in pharmaceutical sales. Does medical patients’ insistence on being prescribed medications they’ve seen on TV result in better care? We don’t know. But we do know it drives up sales.

“In a decade and a half, the use of prescription medication went up 71 percent. This has added about $180 billion to our medical spending.” But this begs the questions I posed earlier; are we healthier, and do we know what we’re taking?

The medical community had given the era of polypharmacy a black eye because no one knew what the mixture of all those meds did in the body, much less the brain. Now, it is coming back into the armamentarium for treating disease. But the risks remain, and one is that some medications can break down into many metabolites that would have unknown interactions with other metabolites. Yes, specialized computer programs at pharmacies may flag some med-med combinations, but do they get all that are problematic?

If a medication has an inordinate number of known side effects, how is that coming happening? What action is resulting from the medication, perhaps one not wanted by the prescriber? How would anyone with basic medical knowledge be able to assess, other than behaviorally, what is happening? I’m not demeaning healthcare professionals, but some questions require answers.

One area where we see polypharmacy again is in psychiatry. I know of a man who has crippling panic attacks every day. His psychiatrist is prescribing Klonopin, Buspar, Gabapentin, and Cymbalta, and he’s still experiencing panic attacks. Now he is seeking relief from TMS.

TMS is a non-invasive treatment that can prompt brain networks to improve their interactions and resolve depression and, possibly, anxiety. Some patients have shown improvement, but not all. So what’s happening with the patients who aren’t responding well to the treatment? And what of the medications patients are taking while they’re receiving TMS? I would suppose that might exclude some patients.

The moral of the story, if this is a story, is we have a long way to go in terms of medications, and I am hopeful that artificial intelligence can prove to be the helper we desperately need. In the meantime, all of us need to keep up on our medications and the potential for problems.

Our healthcare providers may occasionally make slip-ups like the cardiologist who forgot to prescribe potassium required with one drug. Another was an endocrinologist who prescribed a med that required patients have a urinalysis prior to taking the med. He forgot to get one.