Deprescribing Culture
Inappropriate use of medicines is a longstanding problem; a Google ngram for polypharmacy shows it first appeared in 1843 and its usage quarupled in the second half of the 20th century.
Deprescribing has yet to appear on Google ngrams, but is highly prevalence on social media and in more recent academic work. One definition is:
Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes.1
Deprescribing appears to have gained more traction than polypharmacy amongst practitioners. Perhaps because deprescribing does not merely describe the world, but seeks to change it. Invert the act of prescribing, and you give permission to act. A tribe of like-minded people are starting to change the culture. People are doing great work.2
Pharmaceutical marketing, single-disease state evidence based medicine guidelines, government targets, and socio-cultural expectations of treatment added to the problem of polypharmacy.3 Polypharmacy seemed insurmountable. You can try to build a movement on a problem, but a solution is better.
As a meme, deprescribing is an evolutionary shift of emphasis. A pivot. It’s not entirely new, anyone working as an enlightened clinical pharmacist back in the 1990s would have done some, but the stop(p)-start growth of concern about the burden of medicine harms, extension of clinical pharmacists into primary care, prescribing rights, and pharmacogenomics have given greater opportunities to make a difference.
But…
Could a single word change help change practice?
In the case of deprescribing, on balance, I think so.
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Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254–1268. doi: 10.1111/bcp.12732. LINK ↩
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As one example, deprescribing.org is a great example. ↩
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Amongst other things… ↩