J Eval Clin Pract 2004 (Nov); 10 (4): 491–497
Visiting Professor of Prescribing Science,
University of Ulster,
Northern Ireland, UK
Prescribed drugs are now a major cause of morbidity and mortality, particularly in the elderly. The extent of this pandemic is described and its likely causes in primary care are identified: unnecessary prescribing, imprecise diagnosis, inadequate undergraduate and postgraduate education in pharmacology and therapeutics, the uncritical application of evidence-based medicine, the outstanding development of new drugs and their sometimes unjustified promotion. Urgent action is recommended under seven headings, by health administration, epidemiologists, medical educators and prescribing doctors.
Key Points about this article from Dan Murphy, D.C.
Thanks to the American Chiropractor for permission to reproduce this information!
1. Prescribed drugs are a major cause of global morbidity and mortality.
2. Prescription-related disease is a pandemic.
3. Medical doctors:
• Often prescribe drugs unnecessarily.
• Often prescribe drugs with a wrong or “guessed at” diagnosis.
• Are poorly trained in pharmacology.
• Follow evidence based guidelines, which do not work when there is more than one condition requiring more than one drug.
4. About 5 percent of all acute hospital visits are because of prescribed drugs.
5. Seniors over age 70 are the most vulnerable group to prescription drug adverse reactions.
6. 18 percent of all deaths of elderly patients in hospitals are related to prescription drugs, and half of these deaths were avoidable.
7. “More than 70 percent of upper respiratory infections are caused by viruses which will not be affected by antibiotics; but the antibiotics will devastate the normal bacterial flora throughout the body and make it more likely that the viruses will flourish, that secondary pathogenic bacteria will supervene and that resistant strains will emerge.” (WOW!)
8. More than 1000 patients in the United Kingdom die every year of antibiotic-related adverse drug reactions.
9. The most commonly prescribed drugs for children, women, and men are antibiotics, pain drugs and asthma drugs.
10. In the USA, drug-caused illness costs more than $1 billion per year, causes more than 100,000 deaths per year, and is responsible for more than 12 percent of elderly hospitalizations per year.
11. The more prescription drugs a person is on, the more likely that they will suffer a serious adverse reaction (i.e., for seniors, it is 33 percent, if taking six drugs).
12. More patients receive their antibiotics over-the-phone than from actually visiting the doctor, which is “perilously close to malpractice.”
13. In medicine (and probably in chiropractic), diagnostic uncertainty is unavoidable.
14. Many drugs are prescribed with no expectation of improving the underlying condition, but with the hope of symptom relief and placebo effect.
15. It is perfectly correct for GPs to prescribe drugs to relieve symptoms and to use drugs for self-limiting conditions and for non-curable conditions. (I believe that it is perfectly correct for chiropractors to prescribe adjustments, etc., for temporary symptom relief, and for self-limiting, and noncurable conditions.)
16. When a medical doctor prescribes drugs following a presumptive or “guess” diagnosis, the doctor is subjecting the patient to measurable risk of iatrogenic disease, without the certainty of benefit.
17. The most important long-term harm to patients is caused by non-steroidal anti-inflammatory drugs, responsible for over 30 percent of all serious adverse drug reactions. (Wow!)
18. 90 percent of drugs used today have been developed since 1970. Medical doctors are poorly trained in drugs in medical school. It is impossible for a fulltime pharmacologist to have adequate knowledge of all the drugs in use. Prescribing problems resulting in morbidity and mortality are inevitable.
19. The drug industry has played upon the doctors’ relative ignorance of pharmacology to indicate that every new drug is effective and safe, which they are not.
20. It takes a few years of use before a drug’s potential for harm is discovered.
A 1978 graduate of Western States Chiropractic College, Dr. Dan Murphy is on the faculty of Life Chiropractic College West, and is the Vice President of the International Chiropractic Association. For more information, visit www.danmurphydc.com.