Be wary of ‘game-changers:’ Use drugs wisely and safely
Modern medicine has had a wonderful impact on society in the past 50 years but recent events have illustrated that healthcare can do harm as well as good.
Take, for example, U.S. President Donald Trump in May touting hydroxychloroquine, a malaria drug, as a “game changer” ready for immediate use for treatment of COVID-19 and claiming to be taking it himself.
Decisions about the safety and effectiveness of drugs are based almost entirely on what is known as a randomized controlled trial (RCT) in which patients are randomly assigned to receive a treatment or not. Since May, RCTs on the effectiveness of hydroxychloroquine in the treatment of COVID-19 have reported that it produces little or no reduction in the mortality of hospitalized COVID-19 patients when compared to patients who received standard care. It is certainly not the hoped for “miracle cure.”
The situation with hydroxychloroquine highlights the importance of being sceptical of “miracle drugs” such as those advertised on TV and knowing there are risks associated with every medication. This is especially important for people with underlying health conditions (heart disease and stroke, diabetes, long-term lung disease and cancer) who are at increased risk of COVID-19. As well, the more underlying conditions individuals have, the greater the risk of both COVID-19 and polypharmacy.
Polypharmacy is the concurrent use of multiple medications. On average, people over the age of 65 are on six drugs a day. Often the physicians who prescribe the drugs do not communicate with each other, which can result in a patient getting drugs from each of their specialists, like their cardiologist, neurologist, psychiatrist and endocrinologist. Polypharmacy increases the risk of heart disease, atrial fibrillation, high blood pressure, diabetes, long-term lung disease and delirium. Patients, with the assistance of friends, family and healthcare practitioners, need to assess the following:
- Are the drugs you are taking incompatible when taken together?
- Are you able to easily obtain your drugs in your community?
- Are there reasons why you are not taking the medications?
- Are you keeping track of how you are doing while you are taking your medications?
Rather than looking for another pill to cure your next ailment, look in your community for other approaches to improving your health and quality of life. Pain control is a good example of the importance of non-drug approaches to ailments and can eliminate the risk of addiction to pain management drugs that people experience. For example, pain can be decreased and stress relieved with relaxation techniques, such as:
An important fact is that people most at risk may be the ones least able to ask for reviews of their medications. Physicians have a responsibility to de-prescribe drugs after reviewing medications for people with multiple prescribed drugs to stop or decrease side effect risks and improve outcomes. If patients are concerned they have been prescribed multiple medications by different physicians, they should ask their family physician for a full review.
Everyone should check with their doctor before mixing medicines, including over-the-counter medications that also can cause problems. For example, your doctor can review your heart medications and avoid prescribing medications that when mixed with Aspirin and supplements such as omega-3 fish oil and garlic are known to cause problems with thinking ability. Healthcare practitioners are instructed to consider the following issues in a handbook from the U.S. Agency for Healthcare Research and Quality:
- Whether drugs you are taking are incompatible (medication reconciliation).
- Where you obtain your drugs (medical procurement).
- Whether you are not taking the medications and the reasons why (intentional nonadherence).
- Keeping track of how you are doing while taking your medications (ongoing monitoring).
Medicines are part of the reason that modern healthcare has had a tremendous impact on death and disability. However, remember that all medicines can have side effects, especially when taken together.
Larry W. Chambers has authored articles and books on disease prevention, improvements in long-term care homes and innovative approaches for continuing professional development. He is Research Director of the Niagara Regional Campus, School of Medicine, McMaster University.
Hanna Levy and Eva Liu are medical students at the Niagara Regional Campus of the McMaster University, School of Medicine.