Many wondrous discoveries are exceedingly obvious, but only after someone
has by chance pointed them out for the first time.
We propose that a new medical specialty be created, recognized and
certified. Call it what you want. Medical Mixologist, Drugologist,
Integrationist or Interactionist. Perhaps this could be a subspecialty of
internal medicine. The mission is to understand drug effects and
interactions, serve as consultants and advisers to doctors, and see
patients directly for more than the currently ordained 7-15 minutes.
Before explaining, let's review a few facts and statistics.
The United States of America now numbers around 300 million persons, all of
whom are past, present or future patients. Studies have shown that up to 75
percent of patients take their medications incorrectly, also known as
"patient non-compliance."
There are 850,000 physicians practicing between 110 and 150 specialties and
subspecialties. Each has his or her own prescription practices; many have
their habits prescribed for them by insurance companies or employers or
everybody's favorite uncle, Sam.
There are 130,690 pharmaceutical companies worldwide.
These companies market and "market" is the operative word more than
4,000 drugs. The number of drugs and their variants will only continue to
rise.
In 2004, 1.3 billion prescriptions for medication were written. This number
also will only keep rising. Rapidly.
How many medical interactions, in doctors' offices, clinics, hospitals and
emergency situations, are there annually? Like McDonald's Hamburgers Served
Billions and Billions.
Drugs come in capsules, tablets, liquids, patches and all shapes and sizes
and dosages: short-acting, long-lasting, timed-release, continuous. Some
need to be taken once daily, or twice or maybe six times. Some get taken in
the morning or at night, with or without water or juice or whatever. Some
are "as needed."
Next, consider that many patients, especially seniors, take up to a dozen
different medications, often prescribed by several different specialists
who may or may not report back to the primary care physician who hasn't
the time to inquire and may be legally unable to do so for "privacy"
reasons.
Few physicians in the current fly-through atmosphere have, or are allowed,
sufficient time to discuss medications fully with patients.
Nor do most physicians have in-depth understanding. Nurses may, but usually
have little time.
Pharmacists may have such understanding, but they're also harried
retailers.
All medications have side effects, which may vary from patient to patient.
Statistically, however, any patient taking five or more drugs has a 50
percent chance of a bad reaction, from individual medications or drug
interactions. Increase that to eight medications and the chances are 100
percent.
Twenty-five percent of senior hospital admissions are due to misuse of
drugs.
Advertising prescription drugs directly to consumers is now a
multi-megabucks business. Consider that the largest line item of most
pharmaceutical company is sales and marketing.
All of which leads to a conclusion: Relief may or may not be spelled
"R-o-l-a-i-d-s" but the current system for prescribing and monitoring
prescription drug use spells C-H-A-O-S, a chaos leading to harm and death
and lawsuits and the banning of useful drugs because too many people
misused or malmixed them.
Further complicating the chaos is that most Americans now take OTC-meds
and/or some type of vitamin-mineral-herbal supplements. These may interfere
with prescription medications and vice-versa.
A patient's consultation form to see a Medical Integrationist would include
all current meds, ordering physician, dosages, schedules and purposes, as
well as a history of past medication and problems. The Mixologist could
review the record and make recommendations on how to handle real or
potential problems. HMOs, clinics and hospitals would have these
specialists on the staff or on call. Research Mixologists would keep their
colleagues and the general medical population apprised of trends. They
could also participate in, and vastly improve, the FDA's drug approval
process.
Of what benefit are trillions of dollars' worth of physician visits,
diagnostic tests and treatments if medications are not being utilized
safely and effectively?
Our medical associations, specialty certification boards and medical
journal editors should take note and respond quickly to this crisis of
mal-medication, mal-mixing and mal-dosage!
Editor's Note:: Michael Arnold Glueck, M.D wrote this week's column.
