Medications All of Us Should Seriously Consider Deprescribing

Just yesterday I saw an image on a ‘celebrity MD's' social media – it was a mug emblazoned with “Please do not confuse your Google Search with my MD Degree” on it.

It was  a prime example of the arrogance some physicians feel, and a form of micro-aggression. It says, not even so tacitly, ‘I know better than you – and don't bother doing any research on your own because you'd just be questioning my authority with nonsense.'

While yes, there is a lot of nonsense on the Internet, countless women, unable to get a proper diagnosis from doctor after doctor, sometimes for years, have found the answers (and support) they desperately needed on the Internet for conditions like PCOS, endometriosis, Hashimoto's, and others.

Messages like the one on the mug reflect a belief system operational in conventional medicine, sadly sometimes perpetuated by practitioners in other health fields, too, that you, as the patient, are at the bottom of the knowledge totem-pole and you should not be trying to educate yourself. It's an old school, doctor as God, don't worry your pretty little head about it, bad value system happily at play, insidiously eroding our confidence – and worse, it's couched in feminist rhetoric, coming even from women physicians who are telling us, like one celebrity doc is fond of saying. “I'm the MD; I'm the fucking expert here.”

Yet there's a lot we do need to educate ourselves about and there's a lot to critique about goop and the wellness space. And let's not forget, and I talk more about this in ab upcoming podcast interview, we're also sold by “Big Pharma.” And so are your doctors.

Big Pharma, Alive and Thriving

I devote some time each day to keeping up with the latest on conventional diagnostic and treatment methods, including updates on pharmaceutical safety, along with the most recent research on botanicals, supplements, and other natural approaches to healing. It's what I do to be the best integrative physician I can be.

Recently, an article was published in one of the world's most respected medical publications, the British Medical Journal – my personal favorite for its reliability and its self-reflective ability to be critical of conventional medicine – highlighting the importance of questioning medical authority when it comes to pharmaceuticals to avoid overprescribing medications. A major study has demonstrated that “doctors are being unduly influenced by industry-sponsored education events and industry-funded trials for major drugs” and that “those trials cannot be trusted.” They go on to state that the “endemic financial entanglement with industry is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems.” They are calling for taking trials out of the hands of drug and medical device companies, making them independently funded rather than industry-funded.

This is not news to me, nor likely is it surprising to you. Last year another article, directed toward medical doctors, was published – 11 Drugs You Should Seriously Consider Deprescribing. It’s one of several articles of the sort over the past year or so, encouraging doctors to actually learn the evidence for many of the most commonly prescribed pharmaceuticals, to stop prescribing blindly, and overall to prescribe less.

Amongst the pharmaceuticals recommended to deprescribe are:

  • Stool softeners (i.e., Colace): They are routinely recommended for most hospital patients and prescriptions are typically given on hospital discharge, yet there is no evidence of efficacy.
  • Proton pump inhibitors (PPIs): PPIs not only contribute to Small Intestinal Bacterial Overgrowth (SIBO) by reducing the protective stomach acid we need to keep upper gut bacteria in check, but are also associated with reduced calcium and B12 absorption, potentially increasing risks of fracture and neuropathy. They also interfere with thyroid hormone absorption, so if you’re taking a thyroid medication, you may not be absorbing your full dose. While some individuals may need a PPI for a short time, they are associated with rebound acid reflux making them difficult to come off of (I take patients off of these all the time), and too often they are prescribed unnecessarily.
  • Statins for primary heart disease prevention: Statin use has gone up substantially since 2013 when the American Heart Association recommended them for primary prevention of a heart attack; however, the evidence for their use for this purpose is scant, and actually completely lacking for individuals over age 75. Studies have found that putting a woman on a statin for primary prevention increases her risk of developing diabetes, even in women who were previously low risk for diabetes.
  • “Z drugs” – the benzodiazepines like zolpidem, zaleplon, and eszopiclone for sleep: The use of these medications is an all too common and very dangerous practice. Benzos have not only been linked to Alzheimer’s, but studies show that sleep medications in general, across the board, seriously increase a woman’s likelihood of being in a car accident due to impaired reflexes and cognitive function from the medication.
  • Beta-blockers: New studies show that they are not only ineffective for long-term therapy (> 3 years) after a heart attack, but that they might not be that effective for immediate post-MI therapy or even for blood pressure reduction. Yet they have been the mainstay of treatment since 2011.

And the list goes on.

Special Risks to Women

Most medications have never been tested in women while 70% of all pharmaceuticals are prescribed to us. According to one survey, 50% of female Medicare recipients were on at least 5 medications per day, with 12% on 10 or more. Yes, please, take that number in.

Differences in how women metabolize medications put us at greater risk for adverse events compared to men. Even medications we’ve relied on for common symptoms, ibuprofen for menstrual cramps and migraines, for example – have been associated with adverse effects. In the case of ibuprofen, there’s an increased risk of heart attack in women even with infrequent use, and just 10 days of use has been found to reduce fertility temporarily.

Yet pharmaceutical advertising strategically downplays the risks to both practitioners and the general public, while exaggerating the benefits to both of us through direct-to-consumer advertising and professional journals. Women’s bodies are big business for a number of extremely profitable industries. Too often, the recommendation to prescribe less and more discriminately is falling on deaf ears.

Overprescribing of pharmaceuticals has implications not only for the women taking the medications, but also the health of our planet. A 2016 study of fish in Puget Sound found they were contaminated with a veritable pharmacy of medications from Prozac to caffeine to cholesterol medicine, from ibuprofen to bug spray, to personal-care products. What we take, we excrete, and we are contaminating our planet with pharmaceutical waste. Even when it comes to supplements, most are not plant-based or organic; instead they involve the use of complex solvents and other processing materials, and their packaging accounts for a substantial amount of waste.

Fortunately, I spent over 25 years as an herbalist and midwife before venturing into the world of medical practice, allowing me to avoid the pitfalls of overprescribing, and prescribing in the absence of evidence. I got my medical degree so that I could have more of a voice in helping women make healthier, safer choices, and so I could reinvent how women experience health and health care. Having spent decades watching trends in conventional medicine, I spend more time getting women off of unnecessary medications, than prescribing them. Nowadays, ditto that with supplements.

It’s not just Big Pharma that’s profiting off of misinformation. Supplement and alternative testing companies that will check everything from your poop to your genes have become a Wellness Industrial Complex. The supplement industry in the US alone is now a $12 billion a year industry; added to that are billions in testing options that aren’t always highly validated or accurate. There is tremendous incentive in creating diagnoses, selling sickness and selling supplements. Even botanical medicine has gotten swept up in the “frenzy” – generating billions of dollars a year in sales. Yet there is often a complete paucity of data behind many of the claims made for supplement efficacy, creating a caveat emptor situation in a growing wild west both for practitioners and consumers/patients.

Conservative Prescribing

So what can you do? Learn the principles of conservative prescribing that physicians should be adhering to, and apply these to any pharmaceuticals you're prescribed or are currently taking. This means making the commitment to using less medication whenever possible, and taking the least number of products, whether medications or natural alternatives.

Here are the 7 Principles of Conservative Prescribing to ask yourself and your practitioner before starting any prescriptions (or to ask about any you're currently using):

  1. If considering a medication, can I wait and watch for awhile? Are there lifestyle or nutritional, supplement, or botanical alternatives to this medication that have comparable or greater efficacy and safety?
  2. If considering a supplement or botanical, are there lifestyle or dietary alternatives that have comparable or greater efficacy and safety?
  3. Is this medication or supplement really necessary for my symptoms or condition?
  4. Is there evidence to support efficacy? Safety?
  5. Do the benefits adequately outweigh the risks?
  6. What are the cost considerations of the various treatment options to the woman?
  7. Is there a choice that is ecologically preferable (pharmaceuticals contribute significantly to environmental waste, food, animal, and human contamination, and antibiotic resistance from overuse is a global health problem)?

And also, learn which alternatives really work. Here are some examples of nutritional and supplement alternatives for the medications I mentioned earlier, that are also ecologically sound and affordable, and are evidence based:

  • Instead of stool softeners: First, a dietary change, for example, increasing fiber with more vegetables and fruits, can make the difference. Alternatives? Psyllium, which is safe and at a dose of 5 grams per day, does work according to a randomized controlled trial (RCT) comparing the two. Or try senna, which in another clinical trial also surpassed the efficacy of the conventional option.
  • Instead of a PPI, try dietary and lifestyle strategies, or consider a supplement alternative, for example melatonin, which in one small study was associated with a notable decrease in heartburn symptoms at a dose of 3 mg in the evening. Melatonin is thought to be strengthening of the lower esophageal sphincter and is safe.
  • For sleep help, start with sleep hygiene and a circadian rhythm reset. Numerous herbs and botanicals can improve sleep quantity and quality with easily comparable efficacy to most sleep medications (which increase sleep by up to at most usually 30 minutes per night) without the risk. Examples include valerian, hops, passionflower, vitamin B12, melatonin, and magnesium.
  • And when it comes to heart health, the Mediterranean diet is a profoundly effective method for reducing cardiovascular risk, both by preventing but also reversing disease – improving both cholesterol and blood pressure. Garlic has been shown in major meta-analyses to improve cholesterol, and 2 Tbsp. of olive oil per day, eaten in food, has been proven effective for primary prevention of a heart attack.

So let me ask you: psyllium or a stool softener? Statins or olive oil for primary heart disease prevention? Let’s ponder that, but not for too long, because patients can’t wait for safer alternatives. Their lives are on the line.

Don't Stop Asking Questions

From the time we're young we're taught not to question authority, be disruptive, to be polite. But truly, your life can depend on asking the right questions, and pushing back when you need to for yourself or a family member.

It's true, the internet is rife with faux experts who will offer endless advice regardless of their knowledge, training, experience, or having read the research. But the reality is, while MDs do have the training and experience, it's clear that at least when it comes to medications and medical devices, that training and knowledge may be tainted by medical industry influences. They don't mean harm – but harm is happening because most doctors aren't actually aware of the extent of the industry influence, think it's not happening to them, or they're so overwhelmed and stressed that they aren't keeping up with medical research – which is hard to do when thousands of new articles are now published every day. It's why I'm so committed to providing you with content you can trust and rely on. My goal is to do nothing short of reinventing woman’s health so these eventually become worries of the past. But for now, you've got to keep questioning, and making sure you get the answers you deserve. And if you happen to see a physician holding the mug I mentioned, um, well, I'd turn around and walk right out of that office unless it's an emergency!

And, of course, yes, you have to be careful of what you read on the Internet, but if you weren't doing your own research, you might not have found your way here! Which I'm glad you did!