Increasing the pill intake for patients with chronic medical conditions doesn't
improve their health-related quality of life and, in fact, can make them worse,
a new study shows.
Researchers at Los Angeles Biomedical Research Institute near Torrance say there
comes a point where pills actually impede, rather than improve, one's health -
at least for dialysis patients who took an average of 19 pills a day for various
ailments.
"From a quality-of-life perspective, this is something physicians often don't
pay attention to," said Dr. Rajinish Mehrotra, one of the authors of the study,
which appeared this week in the Clinical Journal of the American Society of
Nephrology.
One of the 233 dialysis patients they studied took an astonishing 80 pills a
day. About a quarter of the patients took 26 or more pills a day, with the
average being 19, the researchers said.
The two biggest consequences of this high pill burden are side effects, which
can range from gastrointestinal discomfort to severe nausea, and drug
interactions. Pharmacists don't always communicate with doctors about what drugs
their patients are taking, which can cause serious health problems, the
researchers say.
About two-thirds of the patients studied didn't take their pills as prescribed,
a tendency that increased as the number of pills increased, the study showed.
"Patients can only take so much in one day," Mehrotra said. "It becomes just too
hard to keep track of."
The average person over 65 takes slightly more than four prescription
medications at once, plus two over-the-counter medications, according to the
National Institute on Aging.
Torrance resident Grace Martin, who is in her 70s, said she can barely keep
track of the eight prescribed medications she takes daily, not counting vitamins
and over-the-counter painkillers such as aspirin. She suffers from high blood
pressure, high cholesterol and other conditions.
"I guess that's part of getting old," said Martin, who was not part of the
study. "Sometimes I feel like all I do is take pills and visit the doctor."
Patients who participated in the study were all on dialysis because their
kidneys no longer functioned properly, often a result of diabetes or high blood
pressure.
About half of their medications were so-called phosphate binders, which reduce
the absorption of phosphate into the blood. The other drugs taken by the
patients were to control blood pressure and other health problems.
The researchers found that increasing phosphate binders does not help in
lowering phosphorus levels in the patients' blood stream, likely because they
aren't taking their medication, researchers say.
Dialysis patients in particular take a high number of drugs, typically three or
four tablets just to control phosphate with each meal. Medication can cost
upward of $1,000 for a three-month supply, physicians say.
If phosphate levels remain high, there's only so much doctors say they can do to
control a patient's behavior outside the hospital. That includes diet and taking
medication properly.
"I tell them you have two choices," said Dr. Vinh Cam, a nephrologist at
Torrance Memorial Medical Center. "You can either take your pills, or I'm going
to have to increase the medication. You feel powerless and hopeless sometimes."
The problem of pill burden is likely to become more acute as people age, and as
more people are diagnosed with diabetes and high blood pressure - two of the
most common chronic health conditions, researchers say.
Mehrotra said physicians should be encouraged to try other interventions,
including dietary modification for patients or by making adjustments to their
dialysis regime.
"These are a group of patients who are very sick, and that does require a lot of
interventions," Mehrotra said. "But they can still have a very productive social
and professional life."
