Time To Give Multiple Medications The Bird

Last week ended well with an ‘across the Pond’ call about the de-prescribing process.  Your average ‘gateway medicine’ is easy to get onto but much harder to get off – pill reduction being the tricky bit.  But an enlightened few are already trying, acting as the canaries in the mine, chipping, or should that be chirping away at the harms of many multiple med’s.  Such multi-med’s territory is more formally known as ‘polypharmacy’ in friendly-fire-type speak.

It seems that those of middle age who are ensnared in PolyPharmacy are on a median of seven drugs.  The weaning off process can pay real dividends – via a nuanced balancing of interactions to a careful review of med’s from the ‘most’ to the ‘least’ vital.  Those dividends aren’t just financial but result in a significant improvement in the holistic health of the patient, who rattles less.  To date, two pills are the average level of de-prescribing per patient and the project has a way to go.  So Polly has a smaller Pharmacy in which to operate, yet she is more able to cope with life and has better wellbeing in general.  Yet, with no pills ever tried in clinical trial combinations, you might wonder how it’s come to this with seven as ‘the standard protocol’ of health treatment?

The Antipodean, on the other end of the call, reminded us of the previous Century when during her rounds she only ever encountered patients on a maximum of five meds – woe betide you if you ever asked the Senior Rounds Person if you could prescribe more.  Yet, last year a Cardiologist friend in London mentioned a patient arriving on his doorstep on… wait for it… 38 med’s (doubtless 37 specialists plus a bonus ball for good luck, just in case, to be sure, to be sure).  Yes, in the name of ‘science’ – sadly.

So, could a brave and caring Country mandate a 2020 vision to outlaw any prescribing above five med’s max?  In which case the elephant in the room, becomes more like that smaller guinea pig in the room – that might even be you.  As our call ended, our Antipodean expert seemed pleased as we all embraced her ‘less is more’ medicinal advances.  She was a little fearful for some of her colleagues – those still wedded to their ‘golden eggs’.  She knows some, resistant to patient centric change, who may not appreciate that their Goose is ultimately cooked – and likely they too will go the way of the Dodo.