Poly-Pharmacy: A Different Perspective

As a physician, I am constantly confronted by patients that tell me they don't want to take any medication. I fully understand that, but what is a physician supposed to do when a patient is already on two medicines for their blood pressure and it is still too high? The main two options are to add another medication or have the patient accept the risk of uncontrolled hypertension. The sad fact is that the average number of meds that a patient requires to adequately control their blood pressure is 2.8. Throw in some diabetes and a cholesterol problem (risk factors tend to cluster in patients), and the pill burden on a patient becomes quite substantial. There is a third option, however. It's called lifestyle choices, yet very few patients chose to take the personal responsibility required to control their blood pressure, diabetes and hyperlipidemia without medications. This is a huge issue. Despite gains, cardiovascular disease remains the number one killer in the US, and it is largely preventable.

With the current health care debate, the Democrats frequently quote that the life expectancy in the US versus the money spent is worse than other developed countries. The implication is that our health care system is inferior and overpriced. The reality is that the reason our life expectancy isn't as good as it should be is because we have a culture of obesity, inactivity and fast food which isn't present in other countries. If we have 10 times the amount of diabetes in our society, that is going to be reflected in life expectancy statistics. Only 3% of our adult population lives a healthy lifestyle and has optimum cardiovascular risk factors (maintaining a healthy weight, having a systolic blood pressure of 120 or less, not smoking, having an LDL cholesterol <100 and getting at least 30 minutes of exercise three days per week). Think about it—how many people do you know that fulfill these criteria?

Don't make the doctor the "bad guy" when he tells you that you need more medication. He's not doing it because he likes to prescribe meds. In fact, it's a lot easier for a doc to say "that's close enough" when your blood pressure or cholesterol is a little out of range. Instead of complaining, thank him for caring enough to do whatever he can to keep you healthy, but ask him what you can do from a lifestyle standpoint to achieve the same goal. Then do it.

Dr Al