Ecosystem structure influences human health outcomes as the basis for green prescriptions - Nature

A new Ontario-wide study reveals that common medications, from statins to iron supplements, can set off an unintentional cascade of prescriptions that leave many older adults taking drugs to treat side effects of other drugs. The research, published in BMJ, revealed that certain drug combinations are a common but unrecognized contributor to drug-related harm at the population level and add unnecessary costs to the health-care system. A potentially inappropriate prescribing cascade, as the phenomenon is known, happens when a medication’s side effect is mistaken for a new health problem, leading to another prescription that may not have been needed in the first place. One common example flagged in the study involves non-steroidal anti-inflammatory drugs. Commonly prescribed for pain, these drugs are associated with a rise in blood pressure, which can lead to a new prescription for high blood pressure instead of a second look at the original pain medication. Older adults are especially vulnerable to this pattern because they're more likely to experience multiple conditions requiring multiple medications.

Doctors' prescribing habits are heavily influenced by payments, gifts, and free meals from pharmaceutical companies, leading to more expensive, less appropriate and more drugs being prescribed, a new Cochrane review finds. This can seriously harm both individual patients and health systems. Pharmaceutical companies use a variety of strategies to market and promote their drugs. This can include one-on-one visits by sales reps to doctors' offices and hospitals, gifts and payments including for example paid meals, travel costs to conferences, entertainment, consulting fees, honoraria for participation in advisory boards, and advertising.