You’ve been swindled.

At least that’s the conclusion I’ve come to. It wasn’t the hucksters or the snake oil salesman; it wasn’t big business, big medicine, or some greedy hospital administrator. It was most likely pharma, with help from your physician. Plain and simple. 

I’ve learned quite a bit being a hospice medical director. Covering dozens of new admissions a week has given me much insight into physician prescribing habits. Often, it is my job to decide which medications are necessary and covered by hospice; which are necessary, but not covered by hospice; and which are useless.

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Do you have any idea how many useless and often harmful medications our patients are receiving? I’m not just talking about those at the end of life, but healthy patients too.

Can we talk about multivitamins? Almost every patient I encounter is prescribed a multivitamin, whether healthy, unhealthy, living, or dying. When you’re in the grasps of stage 5 lung cancer and your brain is riddled with metastasis, you have no business receiving multivitamins. It’s not going to help you, and it’s not going to provide that last bit of energy to overcome the calamitous collapse that is rapidly approaching. In fact, there are plenty of data to suggest multivitamins are harmful, if not neutral, at best, even in healthy people. 

How about vitamin D? It seems every patient I encounter is on some sort of vitamin D supplement. Never mind that the vast majority of medical evidence implies that supplementation is unhelpful in most disease processes. Yes, there is osteoporosis, but otherwise, it is a nonstarter. 

Aricept in patients who don’t walk, don’t talk, and barely interact with the world around them? Again, started often because there is no other treatment. Patients with profound dementia are submitted to a host of adverse effects, including diarrhea and syncope, without the faintest glimpse of medical benefit.

Vitamin C, vitamin E, and calcium? How about statins in patients without a history of coronary disease with end-stage-opathies and malignant cancers? Do we really think we are going to cut down on cardiac events in the fleeting few months these patients have to live? Are there any data to support this? You better believe these patients get myalgia and other adverse effects.

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Antibiotics for foul-smelling urine, screening urine cultures without symptoms, or agitation in an already agitated patient? It seems that treating non-urinary tract infections has become the national pastime of our healthcare system.

I could go on and on, and don’t even get me started on antibacterials for nonbacterial infections. 

The point is, we are not being careful with our prescribing habits. We are not taking into consideration the wealth of evidence and data regarding some of these treatments. 

And we are not being good advocates.

We are not shielding our patients from harm.