Protecting Patients Popping Piles of Pills

Millions of Americans suffer from polypharmacy, booms the TV. Are you among them? That'd stop you cold on the way to the kitchen during a commercial break, wouldn't it? Polypharmacy means taking a large number of medications, which indeed millions of Americans do. More than 20 million people take six or more prescription and nonprescription drugs; more than 12 million take eight or more.

It's not hard to see how it can happen. Combine a history of heart disease with a couple of everyday complaints like acid reflux and the occasional rebellion from the lower digestive tract and you're talking half-a-dozen meds, easy—a beta blocker, an ACE inhibitor, a cholesterol-lowering statin, and an aspirin for the heart; a proton-pump inhibitor for the heartburn; dietary psyllium fiber for the digestive difficulty. As the typical drug count increases with the pill-taker's age, so does the risk of drug interaction, as well as the possibility that you'll be the victim of newly discovered hazards in one or more of the medications, especially if they haven't been marketed that long.

Pharmaceutical manufacturers are supposed to run studies of a new drug's safety after the drug goes on the market, but getting doctors and patients to sign up for these studies has been difficult. Patients and physicians can directly report problems to the Food and Drug Administration's MedWatch program, but it, too, has had spotty success. An analysis published today in the Archives of Internal Medicine shows that the number of deaths and injuries reported to MedWatch almost tripled between 1998 and 2005, four times faster than the growth in the number of prescriptions written. The FDA says much of the increase is simply due to better reporting. The study authors disagree. Coauthor Curt Furberg, a professor of public health sciences at Wake Forest University School of Medicine and longtime critic of MedWatch, says that the sharp rise "shows [that] current efforts to ensure the safety of drugs are not adequate, and that physicians and patients are unaware of these risks."

How, then, can individual patients learn about drug interactions and other dangers?

Hugo Stephenson, an Australian physician who relocated to the United States many years ago, thinks he can help. Next month he plans to launch iGuard, a service that will assign a five-level "risk rating" to each drug entered by a patient into a personal medical profile, which is housed at the iGuard website after the patient registers. The risk will represent not only the hazards of individual drugs but also potential drug interactions, all keyed to the patient's medical history. Once registered in the iGuard system, patients will receive alerts when new findings emerge. There won't be any charge—Stephenson will strip out details that identify individual patients and sell the data to researchers—and the rather complicated way in which various risks are determined seems sound to me.

As of mid-September, the iGuard site is open for registration, but Stephenson agrees that it isn't ready for use. Currently, drugs are assigned risk levels, but the nature of the risk is not explained. Stephenson promises that when the site is officially up and running, it will feature explanations that patients can then bounce off their doctor. I hope iGuard can deliver. Nothing else has.