VIDEO: A troubling pharmaceutical cocktail | Dee Mangin #WalrusTalks

Polypharmacy-smashing superstar Dee Mangin delivered a compelling talk for The Walrus about the problem of too much medicine.

In just over 8 minutes, she beautifully articulates the issue and a vision of how we can address it.


MedStopper de-prescribing online app now live!

It is with great pleasure that I introduce: 


Polypharmacy, the state of being on multiple (too many) medications, is an increasingly recognized problem. Though variably defined, everyone agrees that polypharmacy leads to dangerous consequences for patients, particularly in the elderly.

It is so much easier to start than to stop a medication. Now, there is help!

An incredible team, mostly from British Columbia, many of whom I'm had the pleasure of working with, have developed this superb resource. MedStopper is an online tool to help stop medications for patients.

Aimed at clinicians, this deprescribing aid allows you to created a medication list, suggests which medications need to be stopped first, and advises the safest way to go about stopping them. 

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Smiley/frowny faces show you the extent to which the medicine: may improve symptoms, may reduce risk for future illness, and may cause harm. If the patient is considered frail, the recommendations are adjusted accordingly.

The tool is a synthesis of many things, so you can view the Beers/STOPP criteria, the NNT or a risk/benefit calculator if available, and print out the plan if you desire.

Not sure if you (or your patients) are on too many medications? Use the Rxisk questionnaire.

Try out MedStopper today and be sure to use the feedback section to let the team know if there are any glitches or errors.

Congratulations to the group on creating this hands-on, easy to use, and practice changing tool. 


Good + Good + Good = Bad? Recognizing the Harms of Polypharmacy


This month, Dr Roger Ladouceur writes in the Canadian Family Physician (CFP) about a 65 year old patient of his with many co-morbidities. He treated her with guideline-based care, resulting in her taking 16 medications and perhaps, as he solemnly suggests, in someone's death.

Not hers.

We will never know, but polypharmacy may have been a factor in why her vehicle careened across the median and struck a pedestrian who was crossing the street, eventually killing him.

It is noble of Dr. Ladouceur to draw attention to this case; it takes a brave person to consider error, reflect meaningfully, and to move forward with purpose. Trying to help this woman achieve health is not a "mistake" by any means, however with the opportunity to take a step back, he saw that in trying to help her, he may have caused harm.

Good intentions are essential to providing good care, but with everything we do, we may cause harm. Polypharmacy is a perfect example of how evidence and guidelines can compound to create an untenable state. As he writes:

I am not the only physician to prescribe so many medications; most of us often prescribe a substantial number. This is not about assigning blame; we are following the recommendations. Each medication is justified for the indication for which it is prescribed. But what happens when they are all taken together, even when there are no drug interactions?
Could it be that, for a man who went for a walk after breakfast, prescribing 16 medications was fatal? Could it be that, sometimes, we do too much?

Read the very thoughtful article here.