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Come off it

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Regular readers may have inferred from articles that have appeared in these pages that medicine is in a death-grip embrace with the drug industry that has been killing millions of innocent people in the name of profit. We have subsequently learned that we have been mistaken in this belief, and that no such relationship exists. We apologize unreservedly to doctors, pharmacists and pharmaceutical conglomerates such as Smirk & Co. for these false imputations.

Come to think of it, that apology was a little too groveling, and way too premature, but there is a new light on the horizon, and it has the inspired name of  ‘deprescribing.’ OK, it’s not poetry, but we’re talking doctors and pharmacists here.

Yes, deprescribing is a movement that is gaining momentum in Canada, where it first started, along with Australia and the UK. As the name suggests, it’s about taking people off prescription drugs. Now, it has always been thought that this is about the most dangerous and irresponsible thing you could ever do to anyone, and at the very least, they’d spontaneously combust within 43 minutes after stopping their medication.

But that’s not happening. Deprescribing Canada (DC) says it has achieved a ‘deprescribing rate’ of 27 percent in just six months—and not one person has exploded. In other words, people who’ve come under the influence of DC have cut the number of pharmaceuticals they take by over a quarter, with no ill effects.

And most patients would like to take fewer drugs, just as any rational person would quite like not to have nails hammered into their skull. One poll discovered that 70 percent of patients said they’d be happy, delirious even, to cut back on their medications provided their doctor agreed.

That can be a stumbling block, of course. With the doctor often getting drug company kickbacks, such as a new computer or an invitation to a vitally important conference that just happens to be in Barbados, their agreement may not be instantly forthcoming.

This is why DC’s strategy is to bypass the doctor and talk directly with the patient, while getting the pharmacist on board too. In one study, when informative brochures were handed out to patients, there was a 27 percent drop in prescriptions for sedatives over the next six months.

“Slowly but surely, we are driving a change in culture. Now when patients see a prescriber, they are empowered to ask if all their medicines are still necessary,” says Cara Tannenbaum, one of the driving forces behind DC.

And something has to give. In Canada, 66 percent of people over 65 are taking at least five medications, and 27 percent are taking 10 or more every day. It’s not an unusual picture. In the UK, around half of those over 65 are taking five drugs a day, and some told University of Cambridge researchers they were taking as many as 23 different tablets daily.1

Prescription drugs are putting five times more older people in hospitals compared to others of a similar age who aren’t taking any medication. The risks even have the World Health Organization worried; in 2017, it pronounced medicine-related harm—in the good old days, we called it iatrogenic—as “a worldwide epidemic.”

Research comes out almost daily to support the view. One recent study has taken a closer look at the proton pump inhibitors (PPIs), more commonly known as antacids, used for heartburn. They are some of the most widely prescribed drugs in the world, and if you can’t get a prescription, you can always buy them over the counter at your local pharmacy. It’s estimated PPIs are prescribed “without a clear indication” 70 percent of the time; yes, doctors are prescribing them as if they were sweets.

But they’re far from that. Nearly 5 percent of people taking a PPI will die from the drug, usually because it makes them more susceptible to heart disease, chronic kidney disease or stomach cancer. And if it doesn’t kill you, the PPI can also cause dementia, pneumonia, and increase the risk of osteoporosis and fracture. All this to treat indigestion.2

The deprescribing movement has come a long way in four years—and it still has a long, long way to go. Right now, it’s too small to worry the likes of Smirk & Co. Should it succeed, we may have to run out that groveling apology for real, and we’d be delighted to do so.



Age Ageing, 2018; 47: 220–5


BMJ, 2019; 365:l1580

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