Polypharmacy
Further to his article on the problems and lack of science with polypharmacy, Dr Le Fanu, writing in the Daily Telegraph, says in an article ‘Polypharmacy’ can lead to something more serious: Multiple medications may trigger adverse drug events with commonly prescribed drugs,
The necessary corollary of the current medical enthusiasm for polypharmacy – the concurrent use of multiple medications – is the reluctance to recognise its adverse consequences. There can be nothing like the reality check of failing to make the connection in one’s own family to prompt a rather more critical approach – as family doctor David Loxterkamp describes in the British Medical Journal.
His son John had just completed his first year in college when he started being troubled by joint pains, nausea and night sweats that left him so exhausted he would retire to bed after supper. He arranged for him to have the usual blood tests that came back positive for the infectious illness Lyme disease (which subsequently proved to be a red herring), but also the severe autoimmune disorder systemic lupus erythematosus, or SLE. And so it was, “with a deep pit in my stomach as his health continued to decline”, that Dr Loxterkamp requested a specialist opinion. Then, “scanning the literature”, as concerned fathers are bound to do, he came across a reference to the anti-acne medication Minocycline as a possible cause of SLE. “I had failed to heed my own advice reiterated to medical students over the years,” he writes, “to always consider that your patient’s symptoms are the result of a recent prescription.”
The specialist had also failed to make the connection raising the grim prospect that his son – now fully recovered after discontinuing his Minocycline – might have ended up taking long term treatment with potent medications for his drug induced SLE.
This might sound an unusual case, but as Dr Loxterkamp observes a survey of 19,000 hospital admissions in Merseyside found that nearly 1,000 were directly related to adverse drug events caused by commonly prescribed drugs.
This phenomenon is reflected in his own small practice where, in the last year alone, three of his patients have warranted hospital admission with pulmonary fibrosis and liver failure from respectively the commonly prescribed antibiotics Augmentin and Nitrofurantoin, and respiratory failure in a patient on low-dose Methadone. While the desire to take pills may be a distinctive feature of our species, a chastened Dr Loxterkamp notes that “doctors’ desire to prescribe them is equally strong and suspect”. (Emphases mine.)
The kitchen of an elderly person!
Instead of curing, as every homeopath understands, the drugs just impose another drug picture/set of symptoms (to which doctors like to give a name so they can then prescribe another drug – probably suggested by a 20 year-old drug rep!). Depending whether or not the new drug disease (which is otherwise known as a proving) is stronger than the existing disease, determines whether the original disease or the “new” one dominates. According to Hahnemann’s experiments, the artificial “drug” disease will always impose its symptoms upon the individual. This is different to natural diseases which only affect us when we are “sufficiently disposed” (Organon, aphorism 31).
Hahnemann explains the power of drugs as such in aphorisms 32 – 34:
Organon aphorism §32
But it is quite otherwise with the artificial morbific agents which we term medicines. Every real medicine, namely, acts at all times, under all circumstances, on every living human being, and produces in him its peculiar symptoms (distinctly perceptible, if the dose be large enough), so that evidently every living human organism is liable to be affected, and, as it were, inoculated with the medicinal disease at all times, and absolutely (unconditionally), which, as before said, is by no means the case with the natural diseases.Organon aphorism §33
In accordance with this fact, it is undeniably shown by all experience17 that the living organism is much more disposed and has a greater liability to be acted on, and to have its health deranged by medicinal powers, than by morbific noxious agents and infectious miasms, or, in order words, that the morbific noxious agents possess a power of morbidly deranging man’s health that is subordinate and conditional, often very conditional; whilst medicinal agents have an absolute unconditional power, greatly superior to the former.Organon aphorism §34
The greater strength of the artificial diseases producible by medicines is, however, not the sole cause of their power to cure natural diseases. In order that they may effect a cure, it is before all things requisite that they should be capable of producing in the human body AN ARTIFICIAL DISEASE AS SIMILAR AS POSSIBLE to the disease to be cured, which, with somewhat increased power, transforms to a very similar morbid state the instinctive life principle, which in itself is incapable of any reflection or act of memory. It not only obscures, but extinguishes and thereby annihilates the derangement caused by the natural disease. This is so true, that no previously existing disease can be cured, even by Nature herself, by the accession of a new DISSIMILAR disease, be it ever so strong, and just as little can it be cured by medical treatment with drugs which are incapable of producing a SIMILAR morbid condition in the healthy body.
(Emphases George Vithoulkas’s.)
Ref.: Vithoulkas.com: aphorisms 30-34 (Also available here)
Contrast Between Homeopathic and Medical Prescribing
In contrast to this mixopathy and drug provings which patients have to endure, it’s obvious that the rational and scientific approach of Hahnemann, based on three principles: the single remedy; the minimum dose and homeopathicity, is far more scientific and rational, better thought-out and more refined than conventional allopathic medicine – based on no rational principles. Allopathy (medicine) is based on the antithesis of Hahnemann’s principles: polypharmacy; large doses which are not individualised and are either homeopathic (as I’ve shown here), allopathic, isopathic or antipathic: an eclectic mish-mash!
Dr Loxterkamp’s website: http://davidloxterkamp.com/
Update
On polypharmacy Dr Le Fanu has more to say here:
Towards the end of his life the distinguished physician and President of the Royal College, Professor Michael Oliver – whose obituary recently featured in this paper – became increasingly disillusioned by current medical trends. “Nowadays people are no longer allowed to enjoy being healthy”, he wrote, alarmed at how the lives of many of his contemporaries were blighted by the adverse effects of the medication they had been given to reduce the risk of heart attacks and strokes.
The arteries, he noted, become ‘more rigid with advancing years’ thus lowering the blood pressure can reduce the blood flow to the brain causing dizziness, while the commonly prescribed beta blockers ‘slow both mental and physical activity’. He was similarly concerned how frequently those taking cholesterol lowering drugs are ‘disabled’ by muscular pains and weakness and urged doctors to take the necessary steps to allow people to return to their ‘previously unencumbered lives’.
Professor Oliver’s authoritative and forcefully expressed views are particularly welcome given the latest twist in the saga of over medicalization – as illustrated by the concerns of a daughter for her mother in her mid seventies who has been on the standard fistful of drugs for the past two years. She has recently become very depressed after being diagnosed with ‘early’ dementia, is reluctant to eat and has a constant feeling of being cold and dizzy throughout the day.
There is, or should be, no difficulty in recognising the adverse effects associated with specific drugs, but when taken together the interaction between them may, as here, result in what is known as a ‘geriatric syndrome’ – the generalised frailty and functional and cognitive impairment that is not unusual in the very elderly requiring residential care. Thus polypharmacy is and of itself a direct cause of decrepitude in those who might otherwise be enjoying a healthy old age.
Further Update
Recanting the life-threatening experience of cardiology professor Desmond Julian’s experience of taking heart medication and the lack of knowledge between short and long-term taking of medications, Dr Le Fanu says in his article Long-term safety of drugs for life:
The dangers of polypharmacy, a recurring theme in this column, are prodigiously compounded, observes retired Professor of Cardiology Desmond Julian, by the current practice of prescribing drugs indefinitely, “even though their long-term safety and efficacy are unknown” – as he knows only too well from personal experience.
Following a heart attack in his early seventies, Professor Julian commenced the currently recommended quartet of “preventive” drugs: statins, aspirin, Ace inhibitors and betablockers. These were initially well tolerated but after a decade of taking the Ace inhibitor Ramipril he developed the distressing, if well recognised, side effect of an intractable cough.
Several years later he had an episode of internal bleeding from the stomach caused by his daily aspirin. Most recently his beta blocker has resulted in two separate, potentially lethal, complications of a profound fall in blood pressure on exertion and slowing of the heart rate (sinoatrial block). “These could have been fatal had immediate help not been available,” he notes.
Two separate issues are at stake here. The first is the “gap of knowledge” (to put it mildly) between the evidence for the short and long-term effects of the use of these drugs. They will over a period of five years modestly reduce the risk of a further heart attack but no one has the slightest clue whether they continue to do so over decades.
Next, it is highly likely that medicines prescribed in late middle age will cause problems later on, and for several obvious reasons, notably an age-related decline in their “clearance” by the liver and kidneys and altered sensitivity to their action.
The scale of adverse effects caused by this (so far) unchallenged routine of prescribing these drugs “for life” could be readily resolved by a “discontinuation” trial – comparing the outcome in those who stop them after an appropriate interval with those who continue taking them. Meanwhile common sense would suggest that, given Professor Julian’s experience, those who do opt out will be doing themselves a favour.
Update January 2016
The Problems with Polypharmacy
A report published in The Journal of the American Geriatrics Society, January 2016: Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study.
Objectives
To investigate the effects of number of medications and Drug Burden Index (DBI) on transitions between frailty stages and death in community-dwelling older men.
Results
Each additional medication was associated with a 22% greater risk of transitioning from the robust state to death (adjusted 95% confidence interval (CI) = 1.06–1.41). Every unit increase in DBI was associated with a 73% greater risk of transitioning from the robust state to the prefrail state (adjusted 95% CI = 1.30–2.31) and a 2.75 times greater risk of transitioning from the robust state to death (adjusted 95% CI = 1.60–4.75). There was no evidence of an adjusted association between total number of medications or DBI and the other transitions.
Conclusion
Although the possibility of confounding by indication cannot be excluded, additional medications were associated with greater risk of mortality in robust community-dwelling older men. Greater DBI was also associated with greater risk of death and transitioning from the robust state to the prefrail state.
March 2016
India: Govt ban on 350 drugs hits Rs 3,800cr of pharma market. “The ban on ‘irrational’ 350-odd fixed dose combination (FDC) drugs… includes medicines “likely to involve risk to human beings”, where safer alternatives are available, and which are found to have “no therapeutic justification”, a panel appointed by the government found.”
And subsequently: After banning 300 drugs, Health Ministry examining 1,700 more products. “The health ministry is examining as many as 1,700 more drug products to determine if those can be termed as safe and efficacious.”
Picture credit: WikiCommons