How doctors should help consumers cut back on prescription drugs

It’s one of the most common medical routines in America, but it has been harming the health of hundreds of people every day.

You visit a cardiologist about your blood pressure, so she writes a prescription to treat it. Then, for your arthritis and back pain, you see a different specialist, who adds different meds. By the time you finish appointments with the urologist and the neurologist, you’ve got a pill organizer at home that rattles like maracas every time you move it.

The sad reality is that too many Americans are ingesting a daily cocktail of Big Pharma prescribed by multiple doctors who typically don’t talk to each other or know each other.

Nearly 4 million seniors now take 10 or more drugs at once, and more than 400,000 people are prescribed 15 or more meds simultaneously. The number of older Americans taking five or more medications has tripled in the past two decades.

Every day, 750 adults who are age 65 or older are hospitalized forside effects from medication, according to the non-partisan Lown Institute.

The overall problem is known as polypharmacy, and it’s the result of a system that gives too many economic incentives to add drugs but few to take them away.

Every consumer should be talking with their doctors about the number and type of prescriptions they take. Do you really need every drug in your medicine cabinet?

Too many prescriptions are renewed without a second thought, especially of the possible consequences, sometimes unknown, of mixing together so many drugs for so many unrelated medical issues.

The clear fix here is systemic. Every American should have one physician who coordinates their care and does regular reality checks about the cumulative effect of all the treatments prescribed by all the specialists.

This should be a job for geriatricians, because most polypharmacy falls hardest on older adults. Though the senior population is surging — for the first time in history, the number of people 65 and older is about to exceed the number of children under age 18 — the number of geriatricians has plummeted by 25% in the past 25 years. The US now has just 7,400 board-certified geriatric doctors. 

That is a serious shortage, and it is projected to grow worse. With so many Baby Boomer retirements, the American Geriatrics Society estimates the US will need 22,000 more geriatricians in the next five years.

Why don’t more medical students want to be geriatricians? A big reason is money. Geriatricians typically receive only a fraction of the pay of specialists like cardiologists, neurologists and dermatologists.

Even so, after four decades of work in the field, I can vouch that geriatrics is one of the most personally rewarding areas of medicine, because my job is to assume care for the whole person, not just a specific ailing body part.

It’s often the most important question I ask: What does a good day look like for you? And what do you need to achieve it?

The classic study showing the value of geriatric care was conducted at the University of Minnesota. With their permission, 154 people with an average age of 76.5 and an average of nine significant medical problems each were randomly split into two groups — one assigned to a team of geriatric doctors and nurses, and the other to their usual physician team. Within 17 months, the seniors assigned to the geriatrics team had lower death rates and only half as many emergency room visits. Subsequent studies another group of seniors found the people receiving care from geriatricians were 25% less likely to become disabled and half as likely to suffer from depression.

If there were a prescribed medicine that cut death rates, reduced emergency room visits, prevented disabilities and helped to fend off depression, Big Pharma and Wall Street would be racing to bring that treatment to market.

Alas, that drug does not exist. What is available to older Americans, however, are geriatric and primary care physicians who should be able to target polypharmacy issues and provide care to the whole person.

Nick Schneeman, M.D., is chief medical officer at Lifespark, a Minnesota-based complete senior health company.