The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills

Apr 25, 2016

By Paula Span

Dr. Caleb Alexander knows how easily older people can fall into so-called polypharmacy. Perhaps a patient, like most seniors, sees several specialists who write or renew prescriptions.

“A cardiologist puts someone on good, evidence-based medications for his heart,” said Dr. Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. “An endocrinologist does the same for his bones.”

And let’s say the patient, like many older adults, also uses an over-the-counter reflux drug and takes a daily aspirin or a zinc supplement and fish oil capsules.

“Pretty soon, you have an 82-year-old man who’s on 14 medications,” Dr. Alexander said, barely exaggerating.

Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.

“It’s as perennial as the grass,” Dr. Alexander said. “The average senior is taking more medicines than ever before.”

Lots of factors probably contributed, including the introduction of Medicare Part D drug coverage in 2006 and treatment guidelines that (controversially) call for greater use of statins.

But older people don’t take just prescription drugs. An article published in JAMA Internal Medicine , using a longitudinal national survey of people 62 to 85, may have revealed the fuller picture.

More than a third were taking at least five prescription medications, and almost two-thirds were using dietary supplements, including herbs and vitamins. Nearly 40 percent took over-the-counter drugs.

Not all are imperiled by polypharmacy, of course. But some of those products, even those that sound natural and are available at health food stores, interact with others and can cause dangerous side effects.


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14 comments on “The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills

  • As a sixty something, I have been prescribed about a dozen.
    My last experience was being prescribed Prozac for a vision problem. Here is how it went: Went to doctor for vision problem. Blood pressure was high. Doctor concluded stress. Stress requires drugs.

    Sooooo, I make my own decisions about prescriptions.



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  • My Father, in his 80s, is currently experiencing exactly this phenomenon.

    When my Father was recently taken into hospital with heart trouble the number of drugs shot up. They began by “experimenting” – no, really, according to my Old Man that’s exactly how the doctors characterized what they were doing – with drug mixes and doses to see what was most effective at reducing his symptoms.

    One of my Grandfathers died (relatively speaking) young. My other three grandparents also had to put up with this kind of regime. I have therefore been able to closely observe that polypharmacy doesn’t do anything for quality of life, which raises the nasty question: What is old age for if it isn’t high quality retirement?

    Like the discussion on birth, and the medical and social interventions made possible by science, so too is there a lot of talk about: When is life at an end?

    The dogmatic view – by far the most common, even among atheists and agnostics – was given to us by Yogi Berra:

    It ain’t over ’till it’s over

    In this view, no expense must be spared to spare a life.

    Witness the ever-rising costs of healthcare in countries that take a humanist, and wealth redistribution, approach. As bitter and twisted as it may, at first, sound I ask you to consider the costs. Now think of the children, and their future.

    The problem is not just that polypharmacy extends life at the cost of the quality of that life – a policy of ever-diminishing returns as my paternal Grandmother, housebound and alone in a tiny flat with only the TV for company most days for the last two decades of her life, would happily confirm were she still alive – it’s that it also takes from the future. Medical establishments, including the many industries that support them, such as Pharmaceutical companies – soak up talented human capital, non-renewable energy and materials, often rare and difficult or impossible to replace. In Britain this cost has reached the point where the National Health Service is the nation’s biggest employer.

    I have already outlived the vast majority of my ancestors. I have a long way to go to beat my grandparents nevertheless, nearly all of the last 10 generations of my family were dead before they reached 35. But scientific advances in medicine have not cheated death, merely postponed it – and at considerable cost, personal and communal.

    Given that this is the peak of our achievements, shouldn’t we pause and take stock?

    What might happen if even a miserly 5% of those healthcare resources were, instead, invested in our children’s (and grand-children’s and great-grand-children’s … ) futures?

    If religions were logical they would rail against improved health care, the moment of death makes no difference to them – if what they say about afterlife is true. Indeed, I have often wondered how religions reconcile health care with the will of the god(s). I conclude that they are more concerned with earthly matters – ingratiating themselves with those likely to be impoverished, in love as well as financially, by death – levering the long-drawn-out torture of modern deaths of which polypharmacy is merely an early phase for many. What a truly disgusting way to make a living.

    But I digress. What should a non-religious view of death be?

    I don’t pretend to have the answer. But, please, let’s at least start a rational and empirical discussion.

    My suggested starting point is this:

    You’re going to die. Get over it.

    Peace.



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  • Stephen of Wimbledon #2
    Apr 27, 2016 at 5:48 am

    The problem is not just that polypharmacy extends life at the cost of the quality of that life – a policy of ever-diminishing returns as my paternal Grandmother, housebound and alone in a tiny flat with only the TV for company most days for the last two decades of her life, would happily confirm were she still alive – it’s that it also takes from the future.

    This is an issue which arises in debates on euthanasia, where the religious “human life of any sort must be protected, regardless of human suffering,” manifests itself, along with politicians who wish to duck responsibility for taking decisions! – Even dodging the issue of empowering others to take their own decisions.

    It is the classic seizing of power by people who are utterly incompetent at taking responsibility for managing the issues – and who won’t even get out of the way and let others deal with matters themselves!



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  • Hi Alan [#3],

    … the religious [say] “human life of any sort must be protected, regardless of human suffering”

    Anyone who has seen true human suffering, and can say that, is a diabolical, inhuman, immoral monster.

    … politicians who wish to duck responsibility for taking decisions!

    Yes, I always find that an ‘interesting’ position. They spend most of their time saying:

    Put me in charge, I should be in charge, I’m brave – fearless even, I can take it – I know how to make the tough decisions, you can trust me to make the right decision …

    Then, when it comes to a real decision that directly affects every voter:

    Except that one. I can’t decide that one. Quick find me an expert! Okay, find me someone opinionated then, so that they can take the heat off!

    And they wonder why we’re all heartily sick of ‘Professional’ Politicians™.

    Even dodging the issue of empowering others to take their own decisions

    That would never do Alan. That’s democratic.

    It is the classic seizing of power by people who are utterly incompetent at taking responsibility for managing the issues – and who won’t even get out of the way and let others deal with matters themselves!

    No argument from me here.

    Peace.

    ™ Charlatans R Us, all rights reserved.



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  • Steven:
    “What might happen if even a miserly 5% of those healthcare resources were, instead, invested in our children’s (and grand-children’s and great-grand-children’s … ) futures?”

    That is something I have been evaluating every time I go for a procedure now. Whether it is worth it for myself and what will it cost society?



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  • Hi Alf [#5],

    I hope I’m as courageous as you when it comes to my time. For many people even considering their end is just so frightening.

    I have a model. My Grandfather, the one who didn’t die young, decided to die because he was in constant pain, with bouts of very severe pain, while confined to a hospital bed. He managed it with the full knowledge of close family and the Doctors and Nurses simply respected his decision not to intervene when he refused medication a second time. The first time they ignored his pleas and with the help of drugs he let his anger at this inhumanity be known in no uncertain terms.

    Interestingly, for all those Christians out there who think such an act would not be possible for someone of their faith, this man was a lifelong and very strong Christian. Regular as clockwork churchgoer and Church Warden at the central church in a large town he was the major influence on my Mother becoming a priest – which she did after his death.

    I spent some time thinking over his last year. I feel certain that, if he had known what was coming, he would have chosen his end sooner.

    We must each take that journey. Empowering us to decide how we go is, to me, no more than our due.

    My Doctor has been advising that I take statins for the last five years. I know this is the thin end of the wedge.

    Peace.



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  • Steven, I was lucky to be born into an atheist American family. Life has always been questionable for some on this planet. I have lived a full life, I think this IS heaven.
    If I am lucky enough to find out my time is measured in months, my next plan will be employed.

    I have come close to death several times in the last few years. Every time I come laughing back. Enjoy and fulfill your bucket list. Mine is a 1969 Mustang.



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  • First World problem, this. A problem of luxury. We’re so rich we can afford to take all these things to keep us alive a bit longer….

    Tell that to the poor, see how much sympathy you get.

    Meanwhile, I reckon euthanasia should have been onboard from the outset, as soon as life-extending medication became available. Red pill or blue pill, which shall I take today? (available to the over-80s only)



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  • @me #8

    Revised. Red pill vs Blue pill, it would seem ethical to me to have this choice prescribed to anyone who has outlived the span they would have had without the intervention of modern medicine. As certified by a suitable reputable independent medical authority with no vested interest in the outcome.

    The rationale is this: From the scientific/medical viewpoint:

    We’ve kept you alive, so we must also allow you to become dead, simply. Religions, back off, science has extended this life, so science has a duty to allow the life to be voluntarily ended.

    Let’s throw that into the euthanasia debate.



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  • [#7]

    Hi Alf,

    I have come close to death several times in the last few years. Every time I come laughing back. Enjoy and fulfil your bucket list. Mine is a 1969 Mustang.

    I met a man with Parkinson’s disease the other day. He too had a bucket list of cars. He was fortunate enough to be in a well-paid job so he was slowly but surely trading up to the super cars on his list. If I could I surely would send you a ’69 pony, what a beaut!

    You’re so right – getting the most out of the life we have, is where its at. Follow that star.

    Best of luck mate.

    Peace.



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  • [#8 & #9]

    Hi OHooligan,

    A problem of luxury. We’re so rich we can afford to take all these things to keep us alive a bit longer…

    I agree. Health services, of any kind, are a luxury. Scientific medicine is the foundation of polypharmacy; the only type that works unless we count a tiny number of medicines found by chance, luck (a few people survived amputations without contracting deadly infections, for example) and placebos.

    How long has it been? By my reckoning modern science has been going for about 400 years, but didn’t get into medicine for the first 50. That’s about 20 generations. Enough time for those of us in the richer parts of the World to think of our access to medicines as a right – but, thinking the unthinkable, why do we think that? Most of those previous 20 generations would have considered 1960s medicine miraculous. For most of the Earth’s people today that’s probably what’s available – my guess.

    Funny thing, we don’t seem to think of other tribes access to the Polypharmacy as a right. How do I know this? I witness the 3rd World countries begging for relief from epidemics, like AIDS and how they must negotiate their signatures on trade pacts for property ‘rights’ wavers and medicine price cuts funded by rich countries. How they rely on rich patrons in other countries to fund research into their problems, like Malaria.

    Arrogant, us, surely not.

    It isn’t just the young who receive injustice from polypharamacy, but the poor too, while also recognising that we share a dot in the vast cosmic ocean – and there are just too many of us already.

    I hear the euthanasia nay-sayers, and I have great sympathy. No-one wants to lose the only life we’re ever going to get, and no-one wants to lose a loved, and loving, parent, sibling, friend, or even a gifted and hard working stranger. I for one have never forgotten Douglas Adams, I know him only through his works. We never met, but he shapes my thoughts still.

    As certified by a suitable reputable independent medical authority with no vested interest in the outcome.

    This is a key part of the argument. Some people can’t believe that someone who is suffering and dying can be fully compos-mentis. Yet there are many, like me, who have witnessed the truth of this. Safeguards are undoubtedly needed, someone who’s depressed most certainly isn’t in a position to make good choices.

    If I may, I suggest the following edit of your #9:

    Science kept you alive, now science has the power to torture you, very slowly, to death. Allow science to give you the tool that you will, at some point, desperately need to escape and to reach your natural death.

    I understand your stance OHooligan but, religions will play a part in that decision whether we like it or not. I don’t think we can exclude them as you suggest. In the end the whole process must be the patient’s choice and that has to include their religion if they want. Winning the argument on euthanasia will mean holding our noses.

    We desperately, urgently, need to see that death is an integral and inescapable part of life, and to embrace our end as natural.

    We also need to see, as a part of that review, that health services are new in human society and we have not really asked ourselves the hard questions and I believe that you’re right the starting point should be:

    Health services are a luxury, how much can we really afford?

    Peace.



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  • @stepen #11

    Yes, quite right, I agree with all you wrote. You’re welcome to improve the suggested “manifesto” along the lines you wrote, be more polite to the churches if that’s what it takes to get results. Some kind of render-unto-Caesar type thing.

    At the sharp end: if diagnosed with cancer, will you choose to (a) spend a year or so being miserably poisoned by chemotherapy and then die anyway or (b) go for that bucket list while you still can?



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  • [#12]

    Hi OHooligan,

    At the sharp end: if diagnosed with cancer, will you choose to (a) spend a year or so being miserably poisoned by chemotherapy and then die anyway or (b) go for that bucket list while you still can?

    I don’t know. It’s actually quite hard to plan for these eventualities in advance. The meagre resources I command have been my focus for some time, as I have tried to plan for retirement. So slim do my savings seem that I don’t have a wish list for my retirement either. The thing that gets your attention, when you consider retirement and the probable next stage – the polypharmacy gig, is how costly doing your own thing can be and the question arises: How much can I leave for my family? My retirement plan is currently very simple: Stop dreaming and work ’till I drop.

    Choosing a low-quality life in exchange for a shorter, higher-quality, life is the easy way out – particularly as the cost of the pills will be taken up by the taxpayers. It is made easier if your ambitions are, like mine, limited by the small amount of loose change in your pocket. None of us, quite naturally, wants to die, we’ve obviously evolved to have a very strong survive-at-any-cost instinct. This means that polypharmacy always looks to be, at the very least, a viable option.

    The cards are therefore stacked against us, if we want to choose a different end.

    I suspect that means I’ll be like my Grandfather, though choosing my last day will be ever so slightly higher on my list. I really don’t like hospitals.

    That said, my Doctor would laugh at my plan. He says it’s far more likely that drinking, poor diet, lack of exercise, being overweight, high cholesterol, a refusal to take statins, a career spent mostly sitting and a family history of heart trouble means I will probably die from a major coronary or stroke within the next 10 years – well before retirement. Fun guy, my Doctor.

    Peace.



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  • It looks like some of the addictive disinformation based “medications”, are at last on the way out!

    http://www.bbc.co.uk/news/uk-england-nottinghamshire-36324884
    The last pack of UK-made cigarettes has rolled off the production line as the country’s only tobacco factory prepares to shut down for good.

    The closure of Imperial Tobacco’s Horizon factory in Nottingham was announced two years ago and will lead to over 500 job losses.

    Most of the staff will leave next week, with 70 staying on for 18 months as part of the “decommissioning process”.

    The site’s closure has been blamed partly on attitudes to smoking.



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