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Polypharmacy Challenges Physicians

It can be daunting to keep track of new drugs, particularly if the doctor is not prescribing them regularly. During my medical training, I generally was familiar with all of the medicines that patients were taking.  Not so anymore.  Now, it is more likely than not that when I review medication lists, that some of the drugs are unknown to me.  I do my best to remain current in my own specialty – itself a challenge.  I am no longer well versed in the medicines used to treat diabetes, heart conditions and various autoimmune diseases, among others conditions.

Medical illnesses that formerly were managed with just a medicine or two now have many more options.  And the medication lists keep growing.  I wonder at times if some of these new pharmaceutical additions truly add a material advantage over existing options.  For instance, there is an array of effective heartburn medicines that I believe are largely equivalent to each other with respect to safety and efficacy.  The forces that have brought them through R & D to the marketplace are aimed at market share and not to meet an unmet medical need.  Drugs like this are dubbed as ‘me-too’ medicines. 


The young physician starts life with 20 drugs for each disease,
and the old physician ends life with 1 drug for 20 diseases.

Sir William Osler,
The Father of Modern Medicine.

The treatment of inflammatory bowel disease – ulcerative colitis and Crohn’s disease – has become extraordinarily complex with an explosion of new classes of complex medicines which have differing advantages and risks. New ones are released every year.   I suspect that gastroenterology subspecialists who practice only inflammatory bowel disease find it challenging to stay current in the subset of gastroenterology in which they practice. In contrast, I practice general gastroenterology which covers a broad array of my specialty but at less depth than these gastroenterology subspecialists do. 

Some drugs have met the test of time and remain extremely popular.  Aspirin and prednisone and diuretics and analgesics and antibiotics have been in use for decades.  They are safe, inexpensive and effective.  As those of us approaching retirement know, just because something is old doesn’t mean it isn’t useful.

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