Complimentary Pharmacy vs. Polypharmacy

By William K. Summers, MD
© 2001-William K. Summers, MD

Recently, a nursing home administrator approached me about my "problem". According to the administrator, I simply put too many patients on too many drugs. I was practicing polypharmacy.

She cited corporate policy. Any patient on more than nine drugs represented polypharmacy. The doctor had to be corrected. She pointed to the medication list on my patient. The patient was on three inhalers and prednisone for her asthma/emphysema. Three medicines were for her heart failure. One was for her stomach acid reflux. One was for her constipation. One pill was for her severe arthritis pain. The administrator was happy with these ten. She wanted to stop the multivitamin. She did not like the vitamin D for osteoporosis. The melatonin that allowed the patient to sleep without adverse effect on her emphysema was, to the administrator, unnecessary. The antidepressant that allowed the patient to tolerate her miserable circumstances, according to the administrator, should be eliminated.

There has been a campaign to equate "polypharmacy" with demon worship since the 1960's . Professors of medicine and FDA officials decry polypharmacy. This is spin. "Spin" is that there is strong emotional appeal, but no clear definition of the problem. Medical dictionaries define polypharmacy as "administration of excessive medication". This is vague.

Who gets to decide "excessive"? This is important if you are a patient. This is important if your loved one is a patient. In the above example, discontinuing one of the first ten medications would have put the patient into the hospital.

Polypharmacy is when combination of two or more drugs accentuates toxicity. Adding aspirin to Motrin is polypharmacy. Real polypharmacy is like adding whiskey to beer and wine. Real polypharmacy is bad. Arbitrary elimination of medications and health supplements is also bad. Counting vitamins and health supplements among the limit of nine drugs is ridiculous. In fact, any arbitrary number, as a definition of polypharmacy, is wrong.

If a nursing home or a health plan institutes such a policy, your doctor can resist. He must document why each drug is helpful. This is an extra effort on your doctor's part, so be sure to thank them. Complimentary pharmacy is not polypharmacy. Careful selection of drugs can markedly improve the benefit while reducing toxicity. In cancer chemotherapy, combinations of drugs improve survival. Combinations reduce the toxicity of these frightful medications. In cold pills, several compounds work together in complimentary pharmacy.

"Less is More." Professor Art Cherkin at UCLA introduced me to complimentary pharmacy. He pointed out that combinations of herbs and drugs are the tradition of medicine for centuries. The purist movement of one powerful drug for one illness is a recent philosophy. To prove the point, Dr. Cherkin combined two or more drugs to enhance memory and found a striking reduction (as much as 95%) in the optimal dose for enhanced memory.1,2 Each memory drug worked in different ways. They complimented each other. Because they complimented, each compound was effective in a smaller dose. The result is better than expected. Because they work in different ways, the toxicity is reduced. So, "Less is More".

Recently, I used this principle to formulate a combination neuroceutical. It is called "Memory Support" and is a combination of 28 components. In early trials, the result is better than expected. "Memory Support" seems to give a pharmacologic improvement in memory, and energy. Although difficult to measure, the antioxidant combination, should give a more robust, anti-aging result. So when you go to your doctor, pharmacist, or health food store, look for compounds that compliment each other. Explain that you understand that this is not polypharmacy. This is rational complimentary pharmacy.

To your health!!

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