Pharmaceuticalization in health care expresses 4 clinically and ethically troubling trends:
- “Drugs first” or “drugs only” socialization and training of many physicians, physician assistants, and nurse practitioners
- A tendency for clinicians to prescribe medications indefinitely without appropriate follow-up review of patients’ care plans
- Direct-to-consumer advertising and website- and social media-based promotion of prescription drugs by “influencers”
- Promotion of branded pharmaceuticals to prescribers by pharmaceutical sales representatives, key opinion leaders, and other stakeholders in the health care marketplace.
Pharmaceuticalization of health care practice is lucrative for some, costly for patients, and harmful for many. One such harm is polypharmacy, which happens when a patient uses 5 or more medications regularly and concurrently. Deprescribing is a response to polypharmacy: a set of interprofessionally coordinated clinical practices, a goal of which is to eliminate pharmaceutical mismanagement, particularly over- or mis-prescribing, which happens when patients’ medicines are unneeded, unwanted, or not clinically beneficial enough to outweigh risks of taking those medicines. Deprescribing also responds to some clinicians’ failures to recognize polypharmacy interactions among pharmaceuticals, over the counter (OTC) medications, and dietary supplements. Incidence of polypharmacy has prompted the American Geriatric Society to publish and regularly update criteria for managing—prescribing and deprescribing—medications and supplements. Though these criteria were developed to help clinicians care for older adults, they can be more widely applied to a range of patients with polypharmacy, who need deprescribing to be well-coordinated by a prescribing clinician and, when possible, a care team that includes a pharmacist.
“Drugs first” promotions, for example, fueled the opioid crisis, which has alerted prescribers to the necessity of deprescribing as a clinical practice and mindset. This theme issue will investigate how deprescribing plays key roles in avoiding a wide range of risk for iatrogenic harm. This issue also welcomes contributions that explore deprescribing, more conceptually, as a counter force to the pharmaceuticalization of patient care.
Manuscripts submitted for peer review consideration and inclusion in this May 2027 issue must follow Instructions for Authors and be submitted by 30 June 2026.
The AMA Journal of Ethics® invites original, English-language contributions for peer review consideration on the upcoming themes.