The Prescription Cascade: Why Less Is Often More in Medicine

The Prescription Cascade: Why Less Is Often More in Medicine

Recent guidance from the Royal Australasian College of Physicians (RACP) has brought renewed attention to a critical issue in modern medicine: the growing concern around overprescription and what experts call the “prescribing cascade.” This development aligns perfectly with what we at Correct Dosing have long advocated – the crucial importance of appropriate, minimal dosing in medical treatment.

The Heart of the Matter

“Patients should only take essential, proven medicines, and for safety at the lowest necessary dosage,” emphasises Professor Simon Dimmitt, highlighting a fundamental principle that resonates strongly with the RACP’s new guidelines. “Unnecessary ‘polypharmacy’, prescription of multiple medicines together, increases avoidable interactions and side effects.”

This perspective gains particular relevance in light of concerning statistics revealed by the Australian Commission on Safety and Quality in Health Care. Nearly 40% of Australians aged 75 and over are prescribed more than five medicines simultaneously – a situation that demands our immediate attention and careful consideration.

Understanding the Prescription Cascade

The RACP has identified a troubling pattern in modern medical practice: the “prescribing cascade.” As RACP president Professor Jennifer Martin explains, this occurs when “the side effects of one medicine can be misdiagnosed as a new condition, which may in turn lead to further unnecessary prescriptions.”

This cascade effect exemplifies why Correct Dosing’s approach – focusing on minimal effective dosages – is more crucial than ever. When we start with lower, appropriate doses, we reduce the risk of side effects that might trigger this dangerous cascade of additional prescriptions.

The Evidence for Lower Doses

Our research at Correct Dosing has consistently shown that many commonly prescribed medications can be effective at lower doses than typically prescribed. Our detailed tables for popular drugs like Aspirin and statins demonstrate that maximum dosing often increases side effects without proportionally improving outcomes.

This aligns with the RACP’s new guidance urging medical professionals to “prioritise safer non-medication treatments when they’re equally or more effective and only prescribe medications when required.” It’s a validation of our long-standing position that more isn’t always better in pharmaceutical treatment.

A Path Forward

The convergence of the RACP’s new guidelines with Correct Dosing’s mission presents a clear path forward for both healthcare providers and patients:

  1. Question the necessity of each prescription
  2. Start with the lowest effective dose
  3. Regularly review and reassess medication regimens
  4. Consider non-medication alternatives when appropriate
  5. Stay informed about optimal dosing research

Conclusion

The RACP’s new guidelines represent a significant step toward more mindful prescribing practices in Australia. However, this is just the beginning. As Professor John B Warren, Clinical Pharmacologist & Director of Medicines Assessment in London, notes in his review of Correct Dosing’s work: “The safety profile of a medicine can take many years to define… there is an enthusiasm to maximise dosing in drug development programmes.”

Our mission at Correct Dosing continues to be providing evidence-based guidance for optimal medication dosing. The RACP’s recent announcement reinforces the importance of this work and the growing recognition that in medicine, sometimes less truly is more.

For more information about optimal dosing for common medications, visit our detailed medication tables. The full SBS article referenced can be found here.

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