For the past few decades, there has been considerable concern regarding the number of prescription drugs taken by the elderly population in the U.S. The number of drugs prescribed to those over 65 years of age has grown considerably in the past 25-plus years:1
The same disturbing trend has been quietly affecting children (under 18 years of age) as well. The percentage taking at least one prescription drug (in the past 30 days during the years studied) grew more modestly, from 20.5 percent to 24.0 percent. But the increase in the percentage of children taking three or more drugs jumped up by more than 50 percent during the study period, from 2.4 percent to 3.8 percent.
Of even greater concern is the number of drugs given to children, particularly infants, in hospitals. A study in JAMA Pediatrics (formerly Archives of Pediatric & Adolescent Medicine) presents some sobering data:2
In addition to being exposed to multiple drugs from the first day, many of these children are also exposed to "off-label" drugs. These are drugs that prescribed for children that "have not been formally studied in this population and most are not labeled for use in children."
The authors of an earlier study3 published in the same journal looked at the experiences of patients in 31 pediatric hospitals. They noted that "at least 1 drug was used off-label in 297,592 (78.7%) of 355,409 patients discharged during the study. Off-label use accounted for $270,275,849 (40.5%) of the total dollars spent on these medications."
The study concluded that "most patients hospitalized at tertiary care pediatric institutions receive at least 1 medication outside the terms of the Food and Drug Administration product license. Substantial variation in the frequency of off-label use was observed across diagnostic categories and drug classes. Despite the frequent off-label use of drugs, using an administrative database, we cannot determine which of these treatments are unsafe or ineffective and which treatments result in substantial benefit to the patient."
Children and elderly are the most vulnerable patient populations. This is because they overwhelmingly rely on family members to make / help make their health care decisions. Generally speaking, they are less likely to be informed / skeptical about the drugs they are prescribed.
Children and elderly patients are growth sectors in the drug industry's quest for profit. They are a significant part of the drug industry annual revenue, which now exceeds a quarter of a trillion dollars for prescription drugs alone.
You usually can't be there when your patients take their children / parents to see a medical provider. But you can educate them to ask questions about what drugs are being prescribed and why.4 Your best approach is to seek out medical professionals who have a similar (or at least conservative) philosophy regarding the necessity for drugs and are willing to co-manage your patients. These are the providers you will want to refer your patients to before polypharmacy becomes an issue.
References
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Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
