It might seem unusual for ambulance crews to check the refrigerator of a residence to which they are responding.

They look for a medical power of attorney, which may dictate what measures are acceptable or unacceptable during transport or at the hospital. They also make a sweep of the bedside table and the medicine cabinet and bring whatever vials of medications they find to the emergency room. Medications being so numerous these days, they may be conveyed in a bag labeled Albertsons, City Market or Walmart. At the ER, the staff members there will do simultaneous, formation, rolling eyes.

The considerable prescription-drug abuse from opioids (morphine, Demerol, codeine, and their relatives) killed 27,000 people in 2007, more than heroin and cocaine combined. The bagged vials brought to the ER are a different nightmare, a plastic bag of worms, a Gordian knot. Every medicine or pharmaceutical has at least one drug effect. Adding a second drug opens the possibility for a drug-drug interaction. Additional drugs will exponentially increase the potential for drug and drug-drug effects. So, how much of the illness of the patient in the ER is medication related or complicated?

Our little ER problem is not unique, though it is nonexistent in societies too poor to have access to medications. A German report said “6 percent of all hospitalizations are due to adverse drug reactions and 20 percent of these are caused by drug-drug interactions.” The mean age was 61.7 years and post-discharge they “took an average of 3.5 different drugs,” some of which were drug combinations. Careful patient instruction, more problematic with the very elderly, was emphasized for safety and compliance. Having personally pawed through prescription-filled plastic, this number seems small: In England, prescriptions per person rose from 11.2 annually in 2000 to 17.7 in 2010.

Not trivial is the escalating cost of prescription drugs as reported in the journal Medical Care in October 2005: “Prescription drug expenditures in North America have nearly doubled in the past five years.” In Canada, the increase was 11.6 percent “per annum.” Is this sustainable?

I recently stumbled on a downloadable article from the British Medical Journal (Oct. 1, 2013, researcher Huseyin Naci): “Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study.” The London School of Economics & Political Science, Harvard Medical School and the Stanford University School of Medicine collaborated in the study with more than 300,000 participants. They compared exercise to pharmaceuticals in four areas of demonstrated mortality: “secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure and prevention of diabetes.” Exercise was the equal of the drugs; only for heart failure were the drugs (diuretics) superior.

High blood pressure, diabetes Type 2 and arteriosclerosis are partly diseases of civilization, obesity and inactivity. We are fortunate in Durango for exercise opportunities. Yes, the demonstrated benefits of exercise are a tough sell to a working parent (or parents) with children. This is difficult and very complicated science and more research is needed. Keep your prescriptions for now.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.