To the Editor: Goldney and Fisher recently reported data on medication use in an Australian community sample and estimated the financial savings that could be made if the number of prescribed medications was reduced.1

However, the assumption that the average number of medications per patient could be reduced ignores the large body of evidence that has accumulated over recent years demonstrating under-use of beneficial medicines. Under-prescribing has been identified in the management of a broad range of chronic conditions, including heart failure, ischaemic heart disease, hypertension, atrial fibrillation, asthma, osteoporosis, pain, and depression.2,3 It has been suggested that under-use of beneficial therapies may be an even bigger problem than over-prescribing, especially in older patients.4,5

As Goldney and Fisher did not collect any clinical information about their study subjects, no conclusions can be drawn about whether medications were more frequently over-prescribed or under-prescribed. Focusing solely on reducing the number of medications prescribed may be misguided and may result in poorer health outcomes. A broader view of prescribing is required, recognising that problems result from both over- and under-prescribing, as well as inappropriate dose selection and monitoring.5

In reply: We agree that, because of our research methodology, we could not necessarily assume that any medication prescription was inappropriate, and we noted that on two occasions. However, our economic analysis addressed only those people using six or more prescribed medications (mean, 7.8), and we reported multiple use of same-class medications, and, at times, use of two different preparations of the same medication. Therefore, we believe our estimate of potential cost savings to be conservative. Nevertheless, we accept that our hypothesis needs more formal testing using clinical data.