来源：《经济学人》
原文见刊日期：2023年4月29日
As a pharmacist in a big hospital, Emily Reeve would often see patients overwhelmed by the number of drugs they took each day. “They’d say ‘I take so many medicines that I rattle when I walk’,” she recalls. And she worried that some of the medications these patients were on seemed useless, or even harmful.
作为一名大医院的药剂师，艾米丽·里夫经常看到病人被每天服用的药物数量压垮。她回忆道：“病人会说‘我吃了太多药，走路时都会嘎嘎作响’”。她还担心这些患者服用的一些药物似乎毫无用处，甚至有害。
Dr Reeve’s patients are not unusual, at least in the rich world. About 15% of people in England take five or more prescription drugs every day. So do 20% of Americans and Canadians aged 40-79. Since the old tend to be sicker, the number of pills a person pops tends to rise over time. Of Americans who are 65 or older, two-thirds take at least five medications each day. In Canada, a quarter of over-65s take ten or more.
里夫医生的病人并不罕见，至少在发达国家是这样。在英国，大约15%的人每天服用五种或更多的处方药。在40-79岁的美国人和加拿大人中，有20%的人也是如此。由于老年人往往病情更重，一个人服用的药物数量往往会随着时间的推移而增加。65岁以上的美国人中，三分之二的人每天至少服用五种药物。在加拿大，四分之一的65岁以上的人服用10种或更多。
Not all those prescriptions are beneficial. Half of older Canadians take at least one that is, in some way, inappropriate. A review of overprescribing in England in 2021 concluded that at least 10% of prescriptions handed out by family doctors, pharmacists and the like should probably not have been issued. And even properly prescribed drugs have side effects. The more medicines someone takes, the more they will experience.
并非所有这些处方都是有益的。一半的加拿大老年人至少服用一种在某种程度上不合适的药物。2021对英国过度处方的一项审查得出结论，家庭医生、药剂师等提供的处方中，至少有10%不应该发放。即使是处方正确的药物也会有副作用。人们服用的药物越多，他们体验的副作用也就越多。
“Polypharmacy”, as doctors call it, imposes a big drag on health. A recent study at a hospital in Liverpool found that nearly one in five hospital admissions was caused by adverse reactions to drugs. The Lown Institute, an American thinktank, reckons that, between 2020 and 2030, medication overload in America could cause more than 150,000 premature deaths and 4.5m hospital admissions.
医生们称之为“综合用药”，这对健康造成了很大的拖累。利物浦一家医院最近的一项研究发现，近五分之一的患者住院是由药物不良反应引起的。美国智库洛恩研究所估计，在2020年至2030年之间，美国的药物过量可能导致超过15万人过早死亡，450万人住院。
Getting people off drugs is unfamiliar terrain for modern health systems, which are mostly set up to put patients on them. But that is beginning to change. Doctors, pharmacists and nurses are setting up “deprescribing networks” to try to spread the word. England’s National Health Service published a plan to reduce overprescribing in 2021. The first international conference on it took place last year, in Denmark.
让人们脱离药物对现代卫生系统来说是一个陌生的领域，卫生系统大多是为了让病人服用药物而建立的。但这种情况正在开始改变。医生、药剂师和护士正在建立“处方解除网络”，试图传播这一新词汇。英国国家医疗服务体系在2021年公布了一项减少过度处方的计划。去年在丹麦召开了第一次这方面的国际会议。