Some doctors are amazed by news that the many different medicines found in Anna Nicole Smith's hotel room -- 11 in all -- were prescribed by the same psychiatrist.
But others say that in many cases, doctors can do little to avoid putting patients on multiple medications.
The Florida medical examiner investigating the former Playboy playmate's Feb. 8 death found that the prescription medicines discovered in Smith's hotel room were all prescribed by psychiatrist Khristine Eroshevich, Smith's personal friend.
Moreover, the witch's brew of prescription medications, including three anti-anxiety medications and the rarely used sleeping drug chloral hydrate, was prescribed within the last five weeks of Smith's life.
Not all of the prescriptions were written for Smith. According to the medical examiner's report, eight of them were under the name of companion Howard K. Stern.
Still, in addition to being a grim reminder of the danger of overmedication, the case also presents the question of physician responsibility -- and whether the many Americans who take multiple prescription drugs are also putting themselves at risk.
Multiple Drugs, Multiple Problems
Dr. Joel Saper, founder and director of the Michigan Head Pain and Neurological Institute, notes that sometimes multiple prescriptions are necessary when treating a single patient.
"There are complex patients who have multiple dilemmas," Saper said. "If it is a bona fide patient you are dealing with, it is possible that even a very good doctor will be faced with the reality of dealing with multiple layers of symptoms in a single patient."
But predicting the interactions between certain drugs can be tricky business.
"While the number of drugs matters, it may not be as important as which drugs you are taking," Saper said.
Paul Doering, co-director of the Drug Information and Pharmacy Resource Center at the University of Florida's Shands Medical Center, says the deadly mix found in Smith's body was inexcusable if the doctor was in fact aware that Smith was actually taking all of the medications.
"As I counted them up, I noticed four, five or six medications that have overlapping mechanisms of action," he said.
"I don't know a chemist who would mix all of these together in a beaker, much less in a body, without knowing what to expect," Doering said.
Prescription a 'Double-Edged Sword' for Doctors
The idea that harmful interactions can come part and parcel with certain drug combinations has cast the spotlight on a common dilemma faced by doctors.
In short, how does a physician balance the risks of treatment with the risks of not treating a patient?
Dr. Tim Johnson, ABC News' medical editor, acknowledged on "Good Morning America" that doctors were, in many cases, caught between a "rock and a hard place" when prescribing medications.
"On the one hand, if they prescribe too much medication for a patient … they could be in trouble, even [facing] criminal prosecution," Johnson said.
But there has also been a movement in health care to provide more adequate pain management and mental health management for patients.
"So if they prescribe too little, they could be subject to malpractice," Johnson said.
"It is a double-edged sword," Doering said. "At the same time these medicines control pain and disease, they have some potential for side effects and other risks to health."
The sword may cut a third way as well, says Dr. Scott Fishman, chief of the division of pain medicine at the University of California, Davis.
Fishman says high-profile cases such as Smith's may lead to fear among many patients who take a number of different prescription medications.
"Those cases like Anna Nicole Smith's kind of give the false sense that everyone out there is on medications that are not regulated," Fishman said.
He says such perceptions, as well as overstringent monitoring, could lead to "a chilling effect" on prescriptions for legitimate patients.
"In this way, physicians could become wary for prescribing drugs that patients may need," he said. "What we're searching for is balance, and celebrity cases like this one make it harder for us to strike this balance."
"The solution to the public health problem of overmedication in America does not have to undermine the public health crisis of untreated pain in America," Fishman said.
Still, Doering notes, there are some cases in which patients receive too much medicine for their own good -- even from doctors with the best of intentions.
Sometimes patients demand the drugs. In other cases, physician error is to blame.
"There are probably lesser examples," Doering said. "There are some physicians that do end up prescribing too many medications, and people do end up getting harmed. This may be well-intentioned, but probably misinformed somewhere along the line."
Some patients may even actively seek out drugs or combinations of medicines from more than one doctor. This practice, known as "doctor shopping," results in patients receiving prescriptions from one doctor that another doctor may not be aware of, leading to overlapping effects -- and risks.
Preventing the Problem of Overprescription
Fortunately, there are ways for both doctors and their patients to avoid the potential problems presented by multiple prescriptions.
"There are really very clear, easy steps that doctors can follow, which basically constitute good medical practices," Fishman said, adding that proper examinations, obtaining accurate and complete medical histories, and other measures ensured patient safety.
Doering says patients should also have a more active stake in their health-care decisions.
"Patients must become informed about their own medications," he said. "They must understand as best they can the purpose of the drug, how it should be taken, what the precautions are and what to do if they miss a dose."
Keeping careful track of all medications, as well as going to just one pharmacy, are other steps that patients can take to ensure their safety.
"People should take their drugs seriously," Doering said. "When they do that, they are one step closer to protecting themselves from tragedies such as what occurred here."