Polypharmacy and the Quiet Failure to Connect the Dots

Introduction

Polypharmacy has crept into everyday medicine so quietly that many people no longer notice it. Multiple medications are now the norm, not the exception, even for people who were relatively healthy only a few years earlier.

This isn’t about careless doctors. Most clinicians are intelligent, well-meaning, and under real pressure. The problem runs deeper. Modern medicine has become increasingly poor at stepping back and connecting the dots.

When Medicines Create the Symptoms

In his analysis of adverse drug effects, Dr Guy Hatchard explains how side effects of medication are often mistaken for new illnesses rather than recognised as drug-related harm.

A patient starts a medication. Then they develop fatigue, dizziness, anxiety, sleep problems, memory lapses, sexual dysfunction, or bone loss. Instead of asking whether the drug might be responsible, these changes are given new labels: depression, anxiety disorder, Parkinson-like symptoms, IBS, early onset dementia, heart failure, erectile dysfunction, low libido, osteoporosis, arthritis, or the familiar “age-related decline”.

Another prescription follows. Then another.

This is how polypharmacy grows.

Each diagnosis appears reasonable when viewed in isolation. Very few people pause to ask whether the symptoms began after a medication was introduced or changed.

One Doctor Rarely Questions Another

There is an uncomfortable dynamic at work here.

Doctors are often reluctant to question the prescribing decisions of other doctors, especially specialists. A GP may suspect that a new medication triggered a patient’s decline, but challenging a specialist’s prescription can feel inappropriate or risky.

So the prescription remains. The symptoms are treated instead.

Each doctor focuses on what is in front of them. No one takes responsibility for the whole medication picture. Polypharmacy thrives in that gap.

Guidelines Over Judgement

Layered on top of this is the pressure to follow Best Practice Guidelines and prescribing protocols.

These guidelines are meant to standardise care, but they also provide legal and professional protection. Following them is safe. Deviating from them, even thoughtfully, is not.

This has pushed medicine toward prescriptive practice. Symptoms are matched to diagnoses, diagnoses to protocols, protocols to medications. Funding systems reinforce this by restricting choices to approved medicines, such as those listed by Pharmac - New Zealand's drugs-buying agency.

What is funded gets prescribed. What is not funded is often overlooked.

That does not always align with what is best for the patient.

This prescriptive approach to health aligns nicely with AI becoming the permanent replacement for the General Practice doctor — Yes, coming to you soon - Dr Google!

Coming to you soon - Dr Google!

What Gets Missed: Root Causes

Another part of the picture is rarely discussed: nutrition.

Most doctors receive little to no formal training in nutrition. Yet dietary deficiencies and metabolic problems can contribute to fatigue, low mood, cognitive decline, bone loss, hormonal imbalance, and cardiovascular disease.

Instead of addressing these root causes, symptoms are treated with medication.

A deficiency becomes a diagnosis.A diagnosis becomes a prescription.

It follows the rules. It does not always restore health.

New Zealand: From Low Medication to Heavy Reliance

What makes this especially confronting in New Zealand is how clearly the change can be traced.

From around 1960, New Zealand began a gradual move away from being one of the healthiest and least medicated populations in the developed world. Medication use increased steadily as risk factors, screening, and chronic conditions became increasingly medicalised.

Then, from 1981, the change accelerated sharply.

What Changed in Practice After the Medicines Act of 1981

The Medicines Act of 1981 marked a turning point in how medicines were regulated, approved, and used in New Zealand.

The Act improved consistency and safety by formalising medicine approval and regulation. At the same time, it accelerated pharmaceutical availability and uptake.

Several downstream effects followed:

• A much wider range of medicines entered the market

• Long-term medication, such as for managing asthma, use became normalised

• Prescribing increasingly followed protocols rather than individual judgement

• Lifestyle, nutritional, and preventative approaches were sidelined

The Advertising Loophole

The Act also left open a pathway for direct-to-consumer advertising of prescription medicines.

As a result, New Zealand became one of only two countries in the world to allow this kind of pharmaceutical advertising. The other is the United States.

This changed the doctor–patient relationship. Patients increasingly arrived requesting specific medicines by name, influenced by advertising rather than clinical assessment. Prescribing pressure no longer came only from guidelines, but from consumer expectations shaped by marketing.

The Act was not designed to promote overmedication. But combined with advertising, expanding guidelines, funding structures, and medico-legal risk, it helped create a system where prescribing became easier to start than to question, and far harder to stop.

Today, New Zealand is among the most heavily medicated countries in the world, perhaps exceeded only by the United States. Long-term pharmaceutical use is now routine rather than exceptional.

This did not happen because New Zealanders suddenly became less healthy. It reflects structural changes in how health and illness are defined and managed.

Since 2021: Another Acceleration

Many clinicians and patients have noticed a further shift since the pandemic period began in 2020-21.

There has been a surge in reported health problems, followed closely by increased prescribing. New symptoms are identified quickly, diagnoses are applied earlier, and medications are introduced with less tolerance for watchful waiting.

More health complaints.More diagnoses. More medication.

Review and reversal remain rare.

Dementia Should Make Us Pause

Few diagnoses highlight this failure to connect the dots more clearly than dementia.

Many commonly prescribed drugs can impair cognition, particularly when combined. Sedatives, antidepressants, anticholinergics, blood pressure medications, statins, and painkillers can all affect memory and thinking.

When the decline is gradual, medication effects are easily overlooked. Instead of reviewing and reducing drugs, people are often labelled with irreversible brain disease.

My work documents how polypharmacy can mimic or worsen dementia, sometimes with little attempt to deprescribe or reassess.

This Is Not About Blame

This is not a story about bad doctors.

Most clinicians are doing their best within a system that rewards speed, compliance, and guideline adherence. Polypharmacy is not a personal failure. It is a systemic one.

Relearning a Basic Skill

Connecting the dots used to be a basic medical skill.

It meant asking a simple question: What if the treatment is causing the problem?

Relearning that skill will require fewer automatic prescriptions, more medication review, and a willingness to question existing drugs, even when they come from respected sources.

Until then, polypharmacy will continue to grow quietly, harming people while remaining largely invisible.

When side effects are mistaken for disease, medicine risks becoming its own problem.

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