Polypharmacy on the rise
An off-beat post for an awfully boring news week: polypharmacy is on the rise. What a surprise. This past week, I had a conversation with a patient’s mother. Her daughter was on Adderall XR — a relatively high dose of it, and she was also filling a script for Seroquel (a drug used to alleviated the manic phase of someone with bipolar disorder). Adderall to help her daughter during the day, and Seroquel to help her sleep at night. I couldn’t help but think how much that would suck. At least we’ve come a little ways, though: in the old days, a barbituate would have been used to balance the stimulant. But I still think medicine has a long way to go when it comes to neurophysiological disorders.
Anyway, back to the article: polypharmacy is the practice of prescribing multiple drugs, either for the same thing, or for multiple disorders. The problem is that when you do this, you increase the likelihood of drug interactions and side effects. It’s not uncommon (especially in psych wards) to have patients on 10-20 different medications. Medications breed other medications as drugs are prescribed to combat side effects created by other drugs. Docs love pharmacy students because they like to give them the hard cases to get them to whittle down the meds. (I’m actually looking forward to a VA rotation for this reason.) Peel off the layers, and get them down to what they need to be on, and nothing more. Paring 18 meds down to 4-5 is a huge accomplishment.
So if anyone wants to hire a pharmacy intern for clinical pharmacy work, drop me a line. ;)
Anyway, just waxing verbose on a relatively simple matter. I’ve noticed it’s mostly moms that want their kids medicated. Somewhat affluent, stay-at-home moms who think their kids need to be on all the medications that they themselves are on. So yeah, that’s my cynical take on moms and their kids and psych meds. It’s rare you see a dad freak out that their kid ran out of refills on their Zoloft.
And in semi-related news, it appears as though something other than ADHD is being overdiagnosed in this country: melanoma. How exactly skin cancer can be “overdiagnosed” is beyond me. But then again, I guess I’m not a dermatologist…
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(from the melanoma article)
“Because these extra cases were virtually all early stage cancers and because the overall melanoma death rate remained stable, these findings suggest that the increased incidence of melanoma is largely the result of increased diagnostic scrutiny – that is, skin lesions are being biopsied that would not have been in the past, say the authors. They also suggest that the true occurrence of melanoma has not changed.”
It seems to me that the conclusion of a study with these results would be that, until recently, melanoma has historically been underdiagnosed, not that it is currently being overdiagnosed.
Comment by neight — August 11, 2005 @ 10:09 am