A representational image of medicines. — Pexels/File
ISLAMABAD: In a shocking case of medical excess, a 72-year-old female patient suffering from multiple chronic illnesses including diabetes, hypertension, asthma, chronic kidney disease, hypothyroidism and Parkinson’s was handed a prescription containing more than 34 medicines, many of them from the same therapeutic classes.
The prescription, issued by a senior internal medicine specialist in Islamabad, included antiplatelets, antihypertensives, thyroid supplements, calcium and vitamin D preparations, proton pump inhibitors, sedatives, antipsychotics and renal powders stacked across the day in various combinations. This raises serious ethical concerns over irrational prescribing patterns, potentially motivated by financial incentives rather than patient welfare. This is not an isolated case. An in-depth review of prescriptions by psychiatrists, cardiologists, nephrologists, and orthopedic specialists from Islamabad shows a disturbing pattern of polypharmacy patients being burdened with a laundry list of medicines, often duplicative or conflicting in action.
One psychiatrist prescribed nine different medications, including multiple sedatives and antidepressants with overlapping effects, to a young female patient coping with anxiety and sleep issues. In another instance, a cardiologist prescribed four cardiovascular medications along with supplements and painkillers, some of which were not clinically justified for the patient’s profile.
Multiple prescriptions also revealed the simultaneous use of two or more medications from the same class such as two different proton pump inhibitors, sedatives like alprazolam and zolpidem together, or overlapping vitamin D preparations which goes against rational pharmacological practices and significantly increases the risk of drug interactions, organ toxicity and long-term side effects.
Patients, many from low- to middle-income backgrounds, pay consultation fees ranging from Rs3,000 to Rs6,000 in private clinics only to walk away with prescriptions that can cost Rs10,000 to Rs20,000 monthly, often without any clarity or counseling on what is actually necessary. This unchecked and unethical prescribing practice is not only a burden on the patient’s finances but a serious threat to their safety and well-being.
Healthcare professionals and insiders blame the pharma-physician nexus a toxic relationship where pharmaceutical companies allegedly incentivize doctors with foreign trips, gifts, cash payments and sponsorships to promote their branded drugs. In return, doctors write longer prescriptions, often including unnecessary medications just to meet sales targets.
Dr Faisal Sultan, a renowned public health expert and former federal health minister, acknowledged the gravity of the issue but cautioned against knee-jerk regulatory responses. “Yes, this is an issue. But then when our authorities take notice, if it sometimes ends up being over reach and restrictions with unintended consequences,” he said. According to Dr Sultan, there is no magic solution but a combination of small steps. “Education, reminders, a little inquiry, a little pushback that’s what works.”
He suggested that patients should contest prescriptions, submit written complaints with evidence to the PMDC, and ask questions. “Very often people with chronic and multiple conditions will have justifiable long lists,” he said. “Anyone with hypertension may justifiably have two or three medications. Add diabetes, hyperuricemia and it grows. It’s tricky. Not easy.”
Dr Sultan, currently the chief executive officer of the Shaukat Khanum Memorial Cancer Hospital and Research Centre, also shared practical steps taken at SKMCH&RC to combat this menace. “First, pharma reps are not allowed to visit our doctors. Second, we use structured prescriptions. Third, we have pharmacy review of each item including dose and drug interaction and for antibiotics, there’s a full stewardship program.” He also advocated introducing a standardized prescription format with a column for clinical indication beside each drug, and for warning patients about the dangers of polypharmacy and potential drug interactions.
Officials at the Pakistan Medical and Dental Commission (PMDC), speaking on condition of anonymity, admitted that patients across Pakistan are being burdened with unnecessary prescriptions, diagnostic tests, and even procedures. “Many of these are not required but are being done routinely,” one official said. While they advised patients to approach provincial healthcare commissions and the Islamabad Healthcare Regulatory Authority, they also conceded that in extreme cases, complaints could be filed with the PMDC as well. However, they were quick to admit that the roots of the problem are deeper. “This is an ethical issue, and unfortunately, ethics are not being properly taught at the undergraduate level in our medical colleges. Without instilling moral responsibility in future doctors, reforms will remain incomplete,” one official said. They also called for mass education to empower patients to question unjustified prescriptions.