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The Forum > Article Comments > How many pills are too many? > Comments

How many pills are too many? : Comments

By Andrew Gunn, published 27/8/2009

With so many patients on so many drugs, it is worth considering whether every drug they take is actually essential.

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All very clever, even smug.

But then again if someone reads this, misconstrues the smart message, goes off one/some of their medications, loses their physical or mental balance, then is rushed to hospital, who is to blame?
Posted by plantagenet, Thursday, 27 August 2009 9:45:32 AM
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Although not a professional medical person i find this article refreshingly frank and in my experience - accurate.
I am a fit and active seventy year old and take no drugs at all other than the very minimum dose of Allopurinol - an anti uric acid medication - and only take that as an outcome of two very painful renal colic attacks, and after much soul searching.
After experiencing very bad health in my younger years - teenager and as a young man - and after mainstream medicine had completely failed me (although never forgetting to charge) I went down the path of any number of 'alt med' protocols with indifferent results. After much reading and self analysis I have reached two conclusions:
1. So called 'alternative medicine' - that is medicine that is practiced without reference to scientific analysis and/or verification ( massage, vitamin supplementation, energy modalities in general)- is by and large a confidence trick, albeit a well organized one.
2. Despite the wondrous achievements of modern medicine (and there are many), prescribed medication - ie drug therapy - should be restricted to emergency needs only in the interests of overall health, and habitual self prescribed medication - headache tablets etc - should be avoided.
I now rely in general on an eating protocol arising from personal experience, and a well planned exercise routine.
Posted by GYM-FISH, Thursday, 27 August 2009 10:12:45 AM
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Excellent article.

I carried out an analysis of one clinical trial called JUPITER.

You can find my analyses here:

http://www.mingbaima.com/2009/06/a-reply-to-peter-mansfield-of-healthy-skepticism-part-1/

and here

http://www.mingbaima.com/2009/06/what-is-wrong-with-jupiter/

See also the Healthy Skepticism website:

http://www.healthyskepticism.org/
Posted by stevenlmeyer, Thursday, 27 August 2009 11:31:33 AM
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Am I better off Warfarin to prevent blood clots forming around my prosthetic aortic valve and thereby avoiding a stroke? Of course I am.

And am I better off keeping my blood pressure down with the medication I take? Of course I am.

Do you think I like taking these pills and wouldn't prefer to live without them
Posted by Ditch, Monday, 31 August 2009 8:27:40 PM
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The doctor has a good point; a significant number of admissions to hospital are medicine related. Sometimes there is an interaction between the medicines they are taking; sometimes there is an adverse effect with one of the medicines, but very often the patient is admitted because they weren't taking their medicines properly.

I am a pharmacist and I specialise in medication reviews. I have seen hundreds of patients in the last 6 years and am always surprised when I find a patient who is actually taking what the doctor ordered, no more and no less.

In 70% of the cases the asthmatic patient is not taking their puffers properly.
In at least half of the patients on blood pressure/heart medicines, they are taking over the counter medicines that the doctor does not know about.
Many patients take herbal preparations, to manage the side effects of their prescription medicines, without realising that the herbal medicine interacts with one of their prescription medicines.

Sometimes the doctor adds more medicinies, because the first medicine did not work, but that may be because of an over the counter/supermarket product that is acting against the medicine ordered. In other cases, patients stop taking their medicines, because they don't seem to make things better, or the medicine causes unpleasant side effects. It is well known that, in the silent diseases such as high blood pressure or diabetes, patients connect a feeing of improved well being, with effectiveness of the medicine. Unfortunately, a medicine that lowers blood pressure or blood sugar usually does not make you feel better, even when it is doing good.

If any one is concerned about the number of medicines their loved one is consuming, ask your pharmacist or doctor whether they qualify for a medication review. This is a medicare-subsidised service, that costs the patient nothing, but greatly improvers their understanding of why the doctor wants them to be taking the medicines ordered. At the same time, the doctor gets a great snapshot of what is really going on with the patient.
Posted by bridgejenny, Monday, 31 August 2009 8:57:49 PM
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It's an interesting point that a lot of hospital admissions and medicine related problems are caused by mismanagement of prescribed medicine by the patient. I'm sure there are numerous cases where patients seek medicines from more than one doctor as well in an attempt to obtain medication their other doctor has ceased prescribing or will not prescribe.

But surely, in the majority of cases where patients take what a doctor prescribes, the patient is better off with rather than without the medication. I grant there must also be plenty of cases where patients are over medicated but a generalisation is also fair to make here I think, and that would be that medication by prescribed drugs is preferable to no medication at all.
Posted by Ditch, Monday, 31 August 2009 9:30:31 PM
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Having had my health crash a few years back, I've learnt firsthand the inadequacy of conventional medicine. If I'd relied solely on doctors, I've no doubt I'd be juggling a variety of medications by now and all with little or no affect on the underlying problems that were creating the symptoms I was experiencing.

I've managed to control and/or cure digestive problems, multiple food intolerances, fluctuating blood sugar levels and mental health issues - primarily through the use of diagnostic blood analysis and targeted dietary measures and nutritional supplementation. I'm much more in tune with my body and much more aware of the direct relationship between what I eat and how I feel.

GYM-FISH sounds to me as though he's developed a similar awareness, which I'm sure explains the fact that at age seventy he's still on minimal medication.
Posted by Bronwyn, Tuesday, 1 September 2009 10:37:24 PM
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An interesting article, I think that the comment on unknown drug interactions is especially valid. In your practice (or anybody's) I wonder how much medication is patient driven rather than doctor driven. A difficult statistical point is that whether I, personally, will benefit from this drug or not has a probability of 1 or 0 ( I shall benefit or I shall not benefit). Your NNTs etc of course apply an "average" statement to me in order to derive a probability. A difficulty in interpreting a trial lies in the comparability of the control group to me as individual and patient. BTW, don't let the surgeons off the hook when it comes to unnecessary operations!
Posted by Gorufus, Friday, 18 September 2009 9:24:25 AM
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Great article!

GPs have to be seen to be doing something for their patients and, in the very limited time they have, a prescription meets both their and their patients' needs. It doesn't seem to matter that many patients do not fill their prescriptions and even fewer follow the whole course of treatment as prescribed. If it doesn't work try a more potent drug!

I heartily agree that drug interactions (and you haven't mentioned possible interactions with the non-prescription drugs that GPs don't ask about and patients wouldn't tell anyway nor the increasing possibility of patient falls through using multiple drugs) are poorly understood and the randomised control trials so loved as scientific by the medical profession don't cope with the realities that so many of us take multiple pharmaceuticals and often get them from different GPs so the GP in front of you may not know of a pharmaceutical prescribed by another.

But what about a solution? How about paying GPs to provide pharmaceuticals for their patients? This would make them think twice about the real value of a prescription. They might then start prescribing physical activity and nutrition that, in many cases (like the high blood pressure) may be as useful as pharmaceuticals. Overseas studies have shown decreases in pharmaceutical spending have reduced from 5-10%. Very high price drugs could be exempt from this with appropriate approvals - these are the minority of cases. And how about paying GPs when their patients are well (that is after all what we want isn't it?)rather than when they get ill as we do now? This would encourage more preventative care and a more holistic approach to care.
Posted by John Wellness, Wednesday, 30 September 2009 10:36:06 AM
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It's a mistake throwing a blanket over doctors and prescription drugs and dismissing them all as problems to be solved. It's that bad is it John or have you been watching the 6.30pm "current affairs" TV shows too often with their daring exposes of Australia's ailing health system?

Correct me if I'm wrong, but I'd guess that you've never benefited from taking prescription medicines or never required them to be prescribed. It's easy to be cynical when you haven't experienced the threat to your health that requires medical intervention to put it right.
Posted by Ditch, Wednesday, 30 September 2009 8:05:45 PM
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Hi Ditch
I am not an advocate of not using prescriptions drugs – there clearly is a value to using most of them – and I use them sparingly when I am advised to. And no, I do not watch the current affairs programs – I find that samples of one not terribly compelling evidence nor miracle cure for cancers and so on. However I am equally aware that the “science” behind many pharmaceuticals is considerably weaker than imagined. We seek too many quick solutions and taking another medicine meets that bill. We don’t know enough about drug interactions to know how safe they are. We do know that using as few as four prescription drugs at a time increases the risks of falls, (particularly in the elderly). We also know that, for example physical activity (especially if used in conjunction with healthy nutrition) is just as effective as medicines for type 2 diabetes, and that physical activity is just as effective as antidepressants. I also know that as few as a half of patients fill the prescriptions their doctors recommend and then follow the correct dosage. I am simply looking for an approach that gets the most value out of our tax dollar and believe that a modest reduction in pharmaceutical usage would save us considerable money and might even improve our health status.
Posted by John Wellness, Friday, 9 October 2009 8:17:59 AM
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The other side of the coin is that the science behind many pharmaceuticals achieving their intended purpose is particularly strong. You ought to take a look at the requirements required to get a drug released for public use. It isn't a simple thing to achieve and the time and money spent on pre-release research is significant.

Your claim that all it takes is four drugs to increase the risk of a fall is a vague one. The type of drug is more a factor than the number taken. And all you need to do if you are suffering from depression is to engage in physical activity? Now I know the value of physical exercise, but treating depression isn't as simple as you imply.

I'm not sure what your point is regarding the number of people who use the prescriptions their doctor's give them. If they don't take the drugs as they should do, what does that imply in your opinion?
Posted by Ditch, Saturday, 10 October 2009 4:50:49 PM
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