Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

Mangin, Dee; Garfinkel, Doron

doi:10.1177/2042098619883156

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…This international project is another example of the importance of global cooperation between experts on the topic of polypharmacy and inappropriate medication use. Consequently, this article joins previous publications that have resulted from the fruitful collaborations of IGRIMUP members, including our position statement [ 3 ] and a special IGRIMUP collection of other deprescribing articles [ 2 , 27 – 31 ].…”

Section: Discussionmentioning

confidence: 74%

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study

et al. 2021

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Objective Explicit screening tools and implicit evaluation methods have been developed to assist healthcare professionals in the management of pharmacotherapy in older adults. As prescribing habits and locally available medications vary considerably between countries, guides tailored to the needs of specific regions may be required. We aimed to report the results of the international Delphi validation study for the Turkish Inappropriate Medication use in the Elderly (TIME) criteria set, which aims to detect inappropriate prescribing in older adults in Eastern Europe. Methods The study was conducted between June 2019 and March 2020. Delphi rounds were conducted by the TIME international working group, which included 11 internationally recognized experts in geriatric pharmacotherapy as Delphi panelists. They were asked to indicate to what extent they agreed or disagreed with each TIME criterion, taking into account both the available evidence and their own experience. We used a five-point Likert scale from 1 (strongly agree) to 5 (strongly disagree) and an online software program (SurveyMonkey ® ) to grade the level of agreement. Criteria with a median value of 1 or 2 and a 75th centile value of 1 or 2 were accepted, and criteria with a median value > 2 were rejected. Those with a median value of 1 or 2 but a 75th centile value > 2 were retained, to be assessed in the following round. The initial list of Delphi criteria comprised 153 TIME items. Results After three Delphi rounds, 134 criteria were accepted and seven criteria were rejected, while 12 criteria did not achieve consensus, and so were not included in the final validated set of TIME criteria. Conclusion We developed the internationally validated TIME criteria set based on a Delphi process involving international experts. The validation study suggests that the TIME criteria set can be applied in both central and Eastern European settings. Further studies are needed to assess the utility and benefit of the TIME criteria in reducing inappropriate drug use and improving clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00855-5.

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Section: Discussionmentioning

confidence: 74%

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study

et al. 2021

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“…Even in systems that prioritize primary care, it is difficult for any individual physician to see the effects of isolated treatments. Multiple treatments worsen an ''invisible epidemic'' of iatrogenesis (Mangin and Garfinkel 2019). Molly's ''lucky bag'' or Mary's complaint that doctors are just firing tablets are idioms of distress about the deepening of multimorbidity and polyiatrogenesis.…”

Section: The Harms Of Fragmentationmentioning

confidence: 99%

Depression, Deprivation, and Dysbiosis: Polyiatrogenesis in Multiple Chronic Illnesses

Ecks

2021

Cult Med Psychiatry

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Biomedicine tends to treat “mental” illnesses as if they could be isolated from multiple social and somatic problems. Yet mental suffering is inseparable from complex somatosocial relations. Clinical fieldwork in a deprived area of the UK shows that nearly all the people treated for “depression” are chronically multimorbid, both in their bodies and in their social relations. Mental suffering is co-produced by poverty, trauma, and excessive medication use. Patients’ guts are as imbalanced as their moods. Single vertical treatments make them worse rather than better. In the UK, patients in poorer neighbourhoods do not “lack access” to healthcare. If anything, they suffer from taking too many medications with too little integration. I conceptualize the bad effects of excessive interventions in patients with multiple chronic problems as polyiatrogenesis.

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“…Molly's case gives an insight into the “invisible epidemic” (Mangin and Garfinkel 2019) of patients with multiple health problems receiving multiple poorly integrated treatments that too often cause more harm than good. My point is not that Molly's case is exceptional, but rather that it is not exceptional at all.…”

Section: Overtreating the Underprivilegedmentioning

confidence: 99%

“…Multimorbidity is strongly correlated with protracted medication uses. About half of older adults in richer countries are taking five or more medications (Mangin and Garfinkel 2019: 1). The pharmaceutical industry promotes the regular consumption of five or more medications as necessary for the maintenance of health.…”

Section: Uncovering Multimorbiditymentioning

confidence: 99%

Multimorbidity, Polyiatrogenesis, and COVID‐19

Ecks

2020

Med Anthropol Q

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To date, the strongest predictor for dying with COVID‐19 is suffering from several chronic disorders prior to the viral infection. Pre‐existing multimorbidity is highly correlated with socioeconomic inequality. In turn, having several chronic conditions is closely linked to multiple medication intake, especially in richer countries with good access to biomedical care. Owing to its vertical structure, biomedicine often risks giving multiple treatments in an uncoordinated way. Such lack of integrated care can create complex forms of iatrogenic harm. Multimorbidity is often exacerbated by a pharmaceuticalization of social deprivation in place of integrated care. In this article, I explore the possibility that clusters of over‐medication are a contributing factor to higher death rates from COVID‐19, especially in poorer areas within richer countries. Anthropological perspectives on the social embeddedness of multimorbidity and multiple medication use can expand our understanding of who is most vulnerable to SARS‐CoV‐2.

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Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use

Cited by 9 publications

References 29 publications

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study

International Validation of the Turkish Inappropriate Medication Use in the Elderly (TIME) Criteria Set: A Delphi Panel Study

Depression, Deprivation, and Dysbiosis: Polyiatrogenesis in Multiple Chronic Illnesses

Multimorbidity, Polyiatrogenesis, and COVID‐19

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