When I finished medical school 20 years ago, I rarely saw patients taking 10 different medications… even five was a lot. Now I frequently see patients taking five or ten different medications. A recent study showed doctors writing 33% more prescriptions from 1985 to 1999.
There are good and bad reasons for the upsurge in medication use. One good reason for taking more medications is that a single medication may not fully control a condition. When a disease is understood thoroughly, it may be possible to control it from several different directions. For example, high blood pressure can be lowered by relaxing arteries, by diminishing the rate and strength of heart contractions and by eliminating fluid from the blood vessels. So someone with hypertension might take three or more medications to address one problem.
Another good reason is that when doctors prescribe a medication they must balance risk with benefit. If there is risk of a dangerous side effect, it must be outweighed by some great benefit, such as the possibility of controlling a devastating illness. Recently, pharmaceutical companies have made newer, safer medications. Doctors may now treat a condition that has not yet become severe, since the risk of side effects is smaller. For example, before modern antidepressants became available, psychiatrists worried about serious side effects of earlier antidepressants. A patient had to be very depressed before medication was considered. Now that we have safer antidepressants, we are more likely to treat milder depression.
Another legitimate reason for increased medication use is an aging population with its gradual accumulation of medical ailments.
A less benign reason for increased medication usage is the strong incentive for pharmaceutical companies to persuade physicians to prescribe. The companies have also begun to directly encourage patients to request their products. Since 1997, pharmaceutical companies have been allowed to advertise to the public; this has increased prescriptions in proportion to the advertising. Doctors are also targeted. Every week I receive solicitations to participate in efforts to encourage me to order more medications. Some involve offers to pay me to tell them how I decide which medication to prescribe; some are paid surveys to find out how I influence other doctors’ choice of psychiatric medications; some are invitations to attend a “free” dinner-lecture by an “expert” chosen to be sympathetic to their product. I turn these solicitations down. I believe patient care decisions should be made based on unbiased research and scientifically demonstrated effectiveness and safety: not clever marketing strategies.
With so many medications used, you should make sure all your physicians know all of your current medications (bring an accurate list, or a paper bag of all pill bottles including over-the-counter pills and nutritional supplements). Doctors should be able to justify why each medication needs to be continued, rather than eliminated.