All drugs have side effects. The more medicines someone takes, the more they will experience
Dr Reeve’s patients are not unusual, at least in the rich world. About 15% of people in England take five or more prescription drugs every day. So do 20% of Americans and Canadians aged 40-79. Since the old tend to be sicker, the number of pills a person pops tends to rise over time. Of Americans who are 65 or older, two-thirds take at least five medications each day. In Canada, a quarter of over-65s take ten or more.
Getting people off drugs is unfamiliar terrain for modern health systems, which are mostly set up to put patients on them. But that is beginning to change. Doctors, pharmacists and nurses are setting up “deprescribing networks” to try to spread the word. England’s National Health Service published a plan to reduce overprescribing in 2021. The first international conference on it took place last year, in Denmark.
Overprescribing can become self-reinforcing, says Dr Steinman. Several common drugs block reabsorption of serotonin, another neurotransmitter. Taking too many can cause tremors, insomnia and jerky movements of the arms and legs. Those symptoms are often mistaken for Parkinson’s disease. So drugs for Parkinson’s are added, in what is known as a “prescribing cascade”. These, in turn, can cause low blood pressure and delirium–which are, of course, treated with yet more drugs.
Medication overload persists for several reasons. One, particularly in America, is advertising, which oversells the benefits of medicines, says Dr Farrell. Lack of unified personal health records is another. A cardiologist may prescribe drugs for a patient without knowing what the doctor treating his lungs may have put him on.
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