It is ironic to hear leading medical “authorities” loudly decry the “unscientific” use of relatively harmless nutritional products and natural medicines while turning a blind eye to the widespread and potentially dangerous practice of polypharmacy.
It is common in medicine to put patients on combinations of drugs. The vast majority of these combinations, especially where 3 or more drugs are involved, have never been studied at all, let alone in double-blind trials (with the exception of cancer and AIDS treatment, where drug toxicity demands study). Yet physicians routinely prescribe multiple-drug combinations without considering potential dangers.
It is impossible to accurately predict side effects of a combination of drugs without studying that particular combination in human subjects. Knowledge of the pharmacologic profiles of individual drugs does not in any way assure accurate prediction of how these drugs behave in combination.
More than 100,000 patients in this country die from identified adverse drug reactions (perhaps the 4th to 6th leading cause of death in the US). The number who die as a consequence of polypharmacy is, to my knowledge, unknown. It is unknown because it is not studied.
The argument that prescribing is the “art” of medicine is not valid in defending polypharmacy, because drugs are developed and approved through a “scientific” process (double-blind, placebo-controlled studies). The fact that the medicines are often prescribed for “different conditions” is irrelevant to the patient’s physiology. The idea that “we are doing the best we can,” a frequent defense of polypharmacy, does not constitute a scientific argument in favor of it. We are, indeed, trying the best we can, with tools that do not improve at the rate we would wish! The idea that “there is a limit to how much research can be done,” in no way makes the research unnecessary.
It has been said in the past that less than 30% of conventional medical practice was backed by controlled studies. Has this changed? Are we looking closely enough at our way of practicing? Can the use of unstudied polypharmacy really be considered evidence-based, “scientific” medicine?
Charles Sullivan, DO, Oakland, ME
