Michael Noonan is correct that polypharmacy is a real issue in today’s society. A large number of patients receive at least one prescription medication. But what Noonan neglects to mention in his April 7 BDN column, “The doctor of the future,” leads to an oversimplified argument that unjustly vilifies the practice of traditional allopathic medicine.
While many patients are prescribed multiple medications, it is important to realize that the U.S. Centers for Disease Control and Prevention reports nearly 92 percent of older adults have at least one chronic condition and 77 percent have at least two. As of 2012, about half of all adults had one or more chronic health conditions such as hypertension, diabetes and high cholesterol. When appropriate, health care providers recommend that individuals prevent and manage some conditions with diet and exercise. Treatment guidelines released by the American Diabetes Association even promote the use of exercise and diet as the first line treatment.
More often than not, when providers start a patient on a medication to manage a chronic disease, it is because lifestyle changes such as diet and exercise have not been enough. Noonan states that the doctor of the future will not rely on prescription medications to treat their patients. But where does that leave patients for whom diet and exercise are not enough?
One of Noonan’s arguments is an unreferenced claim that “drugs are the fifth leading cause of death in the U.S.” According to the CDC, between 2003 and 2014 medication-related deaths were not included as part of the top 10 leading causes of death.
There is no doubt that medications have the potential for side effects and that use of any substance beyond moderation can be poisonous. Noonan writes that statins cause insomnia and muscle pain, while patients get blood clots because of birth control. He fails to mention, however, that patients may be changed to other statins to address muscle pain. Additionally, patients who smoke or have hypertension significantly increase their risk of birth control-related blood clots.
These side effects are known to rarely occur, and these medications have gone through extensive research which demonstrates that their benefits far outweigh the risks. Statins are known to greatly reduce the risk for heart attacks and stroke. Birth control is known to prevent 95 percent of pregnancies when taken with typical use and up to 99.9 percent if administered with perfect use. The number of heart attacks, strokes and unintended pregnancies prevented overwhelmingly surpass the number of people who experience the side effects of these medications. This is supported by evidence from a multitude of studies. For health care providers to completely reject the use of these medications because of the rare occurrence of side effects is not only dangerous, it is irresponsible as it puts patients at a much higher risk for fatal consequences.
My arguments are not intended to invalidate Noonan’s concerns. As a pharmacist, I share the same disappointment whenever I see a patient with more than five drugs listed on his or her medication list. This is the reason that I and countless other pharmacists have used our skills to laboriously assess patient medication lists to identify drug-related side effects and unnecessary medication use.
There are always opportunities to improve the health care system but keep in mind, for every patient who may experience a side effect, hundreds more extend their lifespan and regain their quality of life because of medicine. While many patients are displeased with the number of medications they are on, for many, the reality is that their medications are lifesaving.
There is room for improvement in patient care and consideration for alternative treatment services may help us move forward. The integration of pharmacists into the primary care setting allows for thorough review of medication lists and medical records to recommend discontinuation of inappropriate medications. The use of physical therapy and osteopathic manipulation provide nonmedication treatments to improve mobility and functionality. The involvement of nutritionists allows patients to use healthy diets to manage a variety of conditions and prevent the need to use more medication.
The doctor of the future will no longer consist of one person responsible to know everything about treating a patient. It will consist of multiple doctors — doctors of medicine, physical therapy, pharmacy, psychology and, yes, even doctors of chiropractic to provide a holistic approach to care. A collaborative health team instead of the elimination of medication use is the solution to a healthier community.
Charles Gregor Derupe is a doctor of pharmacy and a PGY-1 Pharmacy Resident at Penobscot Community Health Care in Bangor.