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Time for a New Medical Specialty: Medical Mixology

Tuesday, 13 December 2005 12:00 AM

Many wondrous discoveries are exceedingly obvious, but only after someone has by chance pointed them out for the first time. It's like the tale of the guy, a century or so ago, who wandered into the Coca Cola Company's main office with a two-word suggestion:

Bottle it.

And indeed, bottles figure prominently in the revelation about to burst upon the world. Bottles and little plastic canisters and hypodermics and the items they contain. In like manner, our suggestion consists of two words.

Medical Mixology.

We propose that a new medical specialty be created, recognized and certified. Call it what you want. Medical Mixologist (facetiously) or perhaps Integrationist or Interactionist. Perhaps this could be a subspecialty of internal medicine. The mission is to understand drug effects and interactions, serve as consultants and advisers to doctors, and see patients directly for more than the currently ordained 7-15 minutes.

Before explaining, let's review a few facts and statistics.

The United States of America now numbers around 300 million persons, all of whom are past, present or future patients. Studies have shown that up to 75 percent of patients take their medications incorrectly, also known as "patient non-compliance."

There are 850,000 physicians practicing between 110 and 150 specialties and subspecialties. Each has his or her own prescription practices; many have their habits prescribed for them by insurance companies or employers or everybody's favorite uncle, Sam.

There are 130,690 pharmaceutical companies worldwide.

These companies market – and "market" is the operative word – more than 4,000 drugs. The number of drugs and their variants will only continue to rise.

In 2004, 1.3 billion prescriptions for medication were written. This number also will only keep rising. Rapidly.

How many medical interactions, in doctors' offices, clinics, hospitals and emergency situations, are there annually? Like McDonald's Hamburgers Served – Billions and Billions.

Drugs come in capsules, tablets, liquids, patches and all shapes and sizes and dosages: short-acting, long-lasting, timed-release, continuous. Some need to be taken once daily, or twice or maybe six times. Some get taken in the morning or at night, with or without water or juice or whatever. Some are "as needed."

Next, consider that many patients, especially seniors, take up to a dozen different medications, often prescribed by several different specialists who may or may not report back to the primary care physician – who hasn't the time to inquire and may be legally unable to do so for "privacy" reasons.

Few physicians in the current fly-through atmosphere have, or are allowed, sufficient time to discuss medications fully with patients.

Nor do most physicians have in-depth understanding. Nurses may, but usually have little time.

Pharmacists may have such understanding, but they're also harried retailers.

All medications have side effects, which may vary from patient to patient. Statistically, however, any patient taking five or more drugs has a 50 percent chance of a bad reaction, from individual medications or drug interactions. Increase that to eight medications and the chances are 100 percent.

Twenty-five percent of senior hospital admissions are due to misuse of drugs.

Advertising prescription drugs directly to consumers is now a multi-megabucks business. Consider that the largest line item of most pharmaceutical company is sales and marketing.

All of which leads to a conclusion: Relief may or may not be spelled "R-o-l-a-i-d-s" but the current system for prescribing and monitoring prescription drug use spells C-H-A-O-S, a chaos leading to harm and death and lawsuits and the banning of useful drugs because too many people misused or malmixed them.

Further complicating the chaos is that many Americans now take some form of vitamin-mineral-herbal supplements. These may interfere with medications and vice-versa.

A patient's consultation form to see a Medical Integrationist would include all current meds, ordering physician, dosages, schedules and purposes, as well as a history of past medication and problems. The Mixologist could review the record and make recommendations on how to handle real or potential problems. HMOs, clinics and hospitals would have these specialists on the staff or on call. Research Mixologists would keep their colleagues and the general medical population apprised of trends. They could also participate in, and vastly improve, the FDA's drug approval process.

Of what benefit are trillions of dollars' worth of physician visits, diagnostic tests and treatments if medications are not being utilized safely and effectively?

The American Medical Association, the Association of American Physicians and Surgeons, specialty certification boards and medical journal editors should take note and respond quickly to this crisis of mal-medication and mal-dosage!

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Many wondrous discoveries are exceedingly obvious, but only after someone has by chance pointed them out for the first time. It's like the tale of the guy, a century or so ago, who wandered into the Coca Cola Company's main office with a two-word suggestion: Bottle...
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Tuesday, 13 December 2005 12:00 AM
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