Polypharmacy

Big pharma, government and GPs under fire in polypharmacy investigation

A fascinating and informative argument against polypharmacy, looking at evidence that has informed the greater prescribing of statins, anti-hypertensives and diabetic treatments.

Book cover of 'Too many pills: How too much medicine is endangering our health and what can be done about it'

Too many pills: How too much medicine is endangering our health and what can be done about it by James Le Fanu. Pp 263. £13.99: Little, Brown (London), 2018. ISBN 978-1408-709-77-1

According to the new book Too many pills: How too much medicine is endangering our health and what can be done about it by retired GP James Le Fanu, the level of polypharmacy prescribing has increased three-fold over the past 15 years.

We are living longer and subsequently we fall victim to a range of age-related ailments that require treatment, but Le Fanu argues that the rise of polypharmacy mainly results from an extension of treatment thresholds; even those with mildly elevated cholesterol, glucose and blood pressure now qualify for therapy. Indeed, he presents data that clearly illustrate that the biggest increase in prescriptions has been for statins, diabetic and antihypertensive treatments.

While patients undoubtedly benefit from these treatments, Le Fanu makes the point that far more will suffer iatrogenic side effects which lead to a life of misery, a point emphasised throughout the book by examples of patients’ experiences of polypharmacy. Le Fanu describes how the problem of iatrogenic illness was first explored nearly 40 years ago when, over a two-year period, a GP documented the effect in all patients for whom he prescribed a new drug — 40% of patients reported symptoms that were probably associated with the use of a new drug.

So how did we arrive at this sad state of affairs? Le Fanu places the blame at the door of both big pharma and the government: the former for the subterfuge they employed in a desire to increase sales and the latter for introducing a new contract that perversely rewarded GPs for medicating patients.

The following chapters take a closer look at the evidence that informed the greater prescribing of statins, antihypertensives and diabetic treatments. In short, the evidence is not very robust and the author clearly illustrates how the age-old trick of presenting relative rather than absolute risk vastly inflates the actual benefits of a treatment. This seems to be true for all three major classes of drugs, but perhaps what is more concerning is that in the absence of objectivity, treatment guidelines were revised so that the level at which therapy was initiated became even lower. A definite win-win for the pharmaceutical industry. A similar picture emerges for the use of antihypertensives and diabetic treatments. The new GP contract in 2004 also comes under fire for rewarding and incentivising GPs for prescribing treatments through the quality and outcomes framework, which he defines as “quite obviously flawed” since it appears to have had no real impact on improving survival.

Finally, Le Fanu argues that GPs need to prescribe fewer treatments and appreciate that the actual benefit for most patients is minimal. But in an increasingly litigious society, I think it unlikely that the average GP would stop a patient’s antihypertensives or statins.

Overall, this is a fascinating book that provides a create deal of information and is fully referenced. Although, as pharmacists, we too are rewarded for the number of prescription items dispensed, perhaps it is time for us to reflect and recognise the true (or lack of) value of the majority of treatments prescribed.

Rod Tucker

Citation: The Salvadore DOI: 10.1211/PJ.2018.20205166

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Handbook of Drug Administration via Enteral Feeding Tubes

    All you need to know about prescribing or administering drugs via enteral feeding tubes. Over 400 drug monographs as well as facts to inform clinical decision making.

    £54.00
  • BNF for Children (BNFC) 2018-2019

    The BNFC contains essential practical information for all healthcare professionals involved in prescribing, dispensing, monitoring and administration of medicines to children.

    £57.50
  • British National Formulary (BNF) 76

    BNF 76 (September 2018) is your essential reference book for prescribing, dispensing, and administering medicines.

    £57.50
  • Prescribing Adult Intravenous Nutrition

    A practical guide to the principles and practice of adult intravenous nutrition. With numerous illustrations and case studies.

    £40.00
  • Medicines Use Reviews

    Conduct successful Medicines Use Reviews (MURs) with this comprehensive book. Contains evidence-based information, tips and guidance.

    £27.00

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete

Supplementary images

  • Book cover of 'Too many pills: How too much medicine is endangering our health and what can be done about it'

Jobs you might like

  • Pontypool, Torfaen (Tor-faen)

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.

medicaments-24.net/dapoxetine/dapoxetine-30-mg/

http://steroid-pharm.com

сиалис состав