In addition to taking all of one's prescription and otc drugs/supplements with them whenever they visit their primary health care provider, people of all ages should get all their prescriptions filled at one pharmacy. Pharmacists are a vital resource vastly underutilized in the US. As a former home health nurse, I regularly saw patients who were unwittingly doubling their drug dossges and/or using potentially dangerous supplements or otc drugs along with their prescriptions .
4
About those fish oil pills. I'm really shocked that doctors are complaining about people taking fish oil pills. It was my husband's cardiologist who got him started on these things! It was called Lovasa, which is simply a very expensive fish oil. I'm positive my husband wasn't the only prescribed Lovasa, aka fish oil. So why is the medical community all bent out of shape because we take what THEY told us to take?
1
The author should also have addressed the over-abundance of multiple-ingredient OTC meds. Depending on the store, it can be almost impossible to find a cough med, antihistimine, whatever without acetaminophen. I know two people who regularly take Tylenol PM solely for the sleep, not any pain. I have given up trying to explain why it isn't a good idea.
2
Polypharmacy is the rason d'etre of Big Pharma, good luck stopping that train.
6
Excellent studies over the last year from Harvard Medical School, NIH, to UCSF show that the long term use of anti-cholinergic drugs has high correlation to dementia.
Don't know what an anti-cholinergic is? Yes you do. It's MOST OTC drugs. Tylenol PM has Benadryl. All first line anti-histamines--the old anti-allergy drugs that made you sleepy--Benadryl, Contac, Actifed, Chlortrimeton, Tavist. Dramamine for sea sickness., anti-nausea-Phenergan. Sleeping pills--Dalmane, Lunesta, Ambien.
Anit-anxiety Xanax, Klonopin,valium.
Drugs we don't even MENTION to our docs. Dimetane in Dimetapp--EVERYONE uses OTC cold medications. Sure doesn't cure colds or URIs but Big Pharma thanks you!
Take this list to your doc:
https://www.nia.nih.gov/research/announcements/2015/02/use-anticholinerg...
Don't know what an anti-cholinergic is? Yes you do. It's MOST OTC drugs. Tylenol PM has Benadryl. All first line anti-histamines--the old anti-allergy drugs that made you sleepy--Benadryl, Contac, Actifed, Chlortrimeton, Tavist. Dramamine for sea sickness., anti-nausea-Phenergan. Sleeping pills--Dalmane, Lunesta, Ambien.
Anit-anxiety Xanax, Klonopin,valium.
Drugs we don't even MENTION to our docs. Dimetane in Dimetapp--EVERYONE uses OTC cold medications. Sure doesn't cure colds or URIs but Big Pharma thanks you!
Take this list to your doc:
https://www.nia.nih.gov/research/announcements/2015/02/use-anticholinerg...
3
Doctors and Pharmaceutical companies (through T.V. and print ads) push seniors to take loads of meds.
Just go to any nursing home and see how many meds the average patient is on.
My great aunt & uncle are 92 and 95 years old and live on their own, in their own home. They make no secret of their skepticism of all the drugs offered their way by doctors. They both take one prescription medicine.
My uncle sums it up succinctly: You will never have a side effect from a drug you didn't take.
Amen.
I am middle-aged and follow this same principle. Look for natural solutions and live a healthy life. I say no to popping pills for every ache & pain. Growing old is not for sissies.
Just go to any nursing home and see how many meds the average patient is on.
My great aunt & uncle are 92 and 95 years old and live on their own, in their own home. They make no secret of their skepticism of all the drugs offered their way by doctors. They both take one prescription medicine.
My uncle sums it up succinctly: You will never have a side effect from a drug you didn't take.
Amen.
I am middle-aged and follow this same principle. Look for natural solutions and live a healthy life. I say no to popping pills for every ache & pain. Growing old is not for sissies.
10
Why didn't you interview a pharmacist for this article? Pharmacists are experts in medication therapy management; they are the medication experts on the health care team. Pharmacists can do much more than "help coordinate medications."
4
Stephanie, Dima Qato is a pharmacist at University of Illinois Chicago and the lead author of the recently-published article on polypharmacy that sparked the column. She and her co-author were both interviewed extensively.
3
I wish you had given more space to pharmacy education, particularly about medication management.
All medications are tested on patients to make sure that they at least do what they are supposed to do and that they do not harm the patients. Many frequent combinations of two medications have also been studied.
A very serious potential problem is when a third, forth, and maybe fifth or sixth medication is added into the mix.
It is all but certain that no company or agency has done any studies on the interactions of the multiple medications that many patients {especially seniors} take.
If you ask your doctor about any side effects of combining medications A, B, C, and D you will most probably be told that you have to take all of them. If you press the doctor for a real answer it will have to be "none that I'm aware of" at best - which is certainly not "there aren't any."
A very serious potential problem is when a third, forth, and maybe fifth or sixth medication is added into the mix.
It is all but certain that no company or agency has done any studies on the interactions of the multiple medications that many patients {especially seniors} take.
If you ask your doctor about any side effects of combining medications A, B, C, and D you will most probably be told that you have to take all of them. If you press the doctor for a real answer it will have to be "none that I'm aware of" at best - which is certainly not "there aren't any."
3
Too tired to work because your job is crushing you with responsibilities for low pay? The doctor will give you adderall (basically meth) so you can be normal like your peers on adderall.
Too depressed to play with your children because you are about to get laid off and don't know how you will make the next mortgage payment? The doctor will give you prozac so you can be normal like your peers on anti-depressants.
To much in pain because you were rolling coal for some executive too hard and you now have destroyed joints? The doctor will prescribe you oxycontin (heroin) so that you can continue to slave away with your peers that need opiates in order to bend their knees.
The average American can't compete against his methed out peers on prozac who are willing to work 16 hours a day while getting paid for 8 hours with no benefits. Not only does our addicted society hurt us, it helps the 1% by turning us into corporate slaves that strive to be working machines.
Too depressed to play with your children because you are about to get laid off and don't know how you will make the next mortgage payment? The doctor will give you prozac so you can be normal like your peers on anti-depressants.
To much in pain because you were rolling coal for some executive too hard and you now have destroyed joints? The doctor will prescribe you oxycontin (heroin) so that you can continue to slave away with your peers that need opiates in order to bend their knees.
The average American can't compete against his methed out peers on prozac who are willing to work 16 hours a day while getting paid for 8 hours with no benefits. Not only does our addicted society hurt us, it helps the 1% by turning us into corporate slaves that strive to be working machines.
8
The entirety of America is hopped up on drugs. Students have to take adderall in college in order to compete for a job, then they have to take adderall and Xanax when they enter the workplace because all the stimulants have led to high blood pressure and anxiety. At 40, they take adderall, xanax, and now an anti-depressant because their life is a horrible slog for bad pay, and the threat of layoffs is constant. By the time they are laid off at 55 and are forced to retire because no one will hire them, they are on adderall, xanax, Prozac, ambien, and now oxycontin because their bodies are in pain from a life of living in America.
Americans need to stop medicating themselves. It starts in childhood, and never ends. I replaced 5 different medications (at age 25 I was taking adderall, prozac, oxycontin, ambien, and gabapentin) with medical marijuana and getting myself away from the rat race of American society and moving to the mountains. Best two decisions for my health ever. I'll never take an addictive medication from a doctor again.
Americans need to stop medicating themselves. It starts in childhood, and never ends. I replaced 5 different medications (at age 25 I was taking adderall, prozac, oxycontin, ambien, and gabapentin) with medical marijuana and getting myself away from the rat race of American society and moving to the mountains. Best two decisions for my health ever. I'll never take an addictive medication from a doctor again.
2
Polypharmacy can happen when you are prescribed a drug for a condition, and that drug causes side-effects. Then you get a drug for the side-effects, which can cause more side-effects, etc.
This seems to happen a lot to people taking psychiatric meds.
This seems to happen a lot to people taking psychiatric meds.
3
My husband who has since died was on Coumadin and fish oil both on the advice of his Doctor so what do you do when the Doctor is not informed enough ?
3
Most doctors know absolutely nothing about nutrition. I was diagnosed with high cholesterol and was prescribed statins. And what was the doctor's advise? Something like, "remember, there is nothing more important than diet and exercise." That meant nothing to me, and means nothing to most Americans.
Thanks to Dr. Google and Dr. YouTube, I figured it out by eating more fats, and greatly reducing my consumption of carbs (other than green vegetables and some fruit) and refined sugar. I lost 20 pounds, and no longer needed the statins. At age 57, my goal is to take zero prescription medicines for as long as possible.
Joining a gym and regularly attending spinning classes certainly helped, but the key was the removal of most (but not 100%) unhealthy junk food that provided no satiety.
If you have a poor diet and join a gym, you could actually gain weight because the workouts make you hungry, and you eat more of that poor diet.
Thanks to Dr. Google and Dr. YouTube, I figured it out by eating more fats, and greatly reducing my consumption of carbs (other than green vegetables and some fruit) and refined sugar. I lost 20 pounds, and no longer needed the statins. At age 57, my goal is to take zero prescription medicines for as long as possible.
Joining a gym and regularly attending spinning classes certainly helped, but the key was the removal of most (but not 100%) unhealthy junk food that provided no satiety.
If you have a poor diet and join a gym, you could actually gain weight because the workouts make you hungry, and you eat more of that poor diet.
13
I'm 72. As long as I have my wits about me, I will resist 'brown-bag reviews' and anything similarly childish. My HMO has current online records of all of my prescription drugs and regular supplements, and any doctor whom I see can consult them. For prescription drugs, I research everything that a doctor recommends. As of now I'm taking 5 prescription drugs, but have refused statins and 2 other routinely prescribed drugs because of my own personal research about my own personal situation. For prescription drugs, a doctor's information or advice has often been helpful.I also research OTCs, vitamins and other supplements before using them. (See consumerlabs.com.)
Overall, for most of my life I have been able to keep track of medical records and drug decisions much more easily than doctors with many patients to look after. If/when I'm no longer capable of this responsibility, I hope that I'll have a caring person to do it for me.
Overall, for most of my life I have been able to keep track of medical records and drug decisions much more easily than doctors with many patients to look after. If/when I'm no longer capable of this responsibility, I hope that I'll have a caring person to do it for me.
3
I am diabetic and have been on a low-dose statin for 7 years. my old endocrinologist left and my new one sent me to a cardiologist despite no sign of heart disease or high blood pressure. the cardiologist decided my cholesterol numbers were not low enough for him, so he prescribed a stronger statin AND told me to start taking a baby aspirin DESPITE my clearly stating that I get ringing in my ears from it. then the endo prescribed TWO diabetic meds to replace my ONE that was recently pulled from the market. doctors give you drugs without knowing side effects or possible interactions and of course, they know NOTHING about the costs of all these meds. generics do help, but how safe are they, especially now that so many are made in China. every new pill I put into my mouth, I FEAR because most have a laundry-list of potential dangers that seem to outweigh the benefits if you read the accompanying literature.
doctors no longer have time to listen to patients, it's now all just a numbers game. they just pile on MORE and stronger drugs to get you to fit in a box. they over-prescribe as a way to safeguard themselves from malpractice suits. between my 6 prescribed meds and what I take over the counter, I am BROKE despite a good Medicare Part D plan.
and of course in the end, as Jim Morrison famously said, no one here gets out alive, so how much quality of life is really being added by having us patients gulp down the contents of a small drug store daily?
doctors no longer have time to listen to patients, it's now all just a numbers game. they just pile on MORE and stronger drugs to get you to fit in a box. they over-prescribe as a way to safeguard themselves from malpractice suits. between my 6 prescribed meds and what I take over the counter, I am BROKE despite a good Medicare Part D plan.
and of course in the end, as Jim Morrison famously said, no one here gets out alive, so how much quality of life is really being added by having us patients gulp down the contents of a small drug store daily?
6
I am 56. I have been taking a statin for many years because my mother died young of heart disease. My overall cholesteral was good, my HDL has always been very low and my doctor (female) thought I should be on a statin. I also take 2 blood pressure drugs, and for anxiety/depression I take something which has really helped me. Thyroid issues run in my family and my numbers were low so I take Levo... My A1C was borderline so an endo gave me Metformin. I've also had chronic GERD since I was in my 20s and take meds for that. I also take calcium and vitamin D. I take a multi but usually forget to take my Omega3.
I'm actually embarrassed when I pick up my meds at the drugstore, but which ones should I give up? My info is all in the same computer system and each doctor reviews what I take and what medical issues I have and print it all out. I am probably very fortunate in that regard. I can't really get off many of these - I could lose weight and possibly get off the Metformin which is a goal.
I'm actually embarrassed when I pick up my meds at the drugstore, but which ones should I give up? My info is all in the same computer system and each doctor reviews what I take and what medical issues I have and print it all out. I am probably very fortunate in that regard. I can't really get off many of these - I could lose weight and possibly get off the Metformin which is a goal.
1
These days, that's all our greedy doctors have time to do: Prescribe another pill or send you down to the MRI machine they just recently bought. Patient care has been boiled down to that. I take a real grab bag full of poisons, some of which do me some good, some which don't seem to, and some which are very harmful. For example, I was needlessly overdosed with Zocor. Results: type 2 diabetes and vascular parkinsonism. This kind of thing results from doctors who can't think out of their narrow boxes and don't have the time to try.
4
While many of the comments below show knowledge of what medications they are taking, it's frightening when I speak with my friends about their medication that they really don't know what or why. Patients, if able, should be more cognizant about their medication.
4
Good story..you can abuse anything including motherhood, apple pie and our medical system.
You have insight into the problem, not like other groups, people in authority etc. who sugar coat our medical system like it was infallible.
You have insight into the problem, not like other groups, people in authority etc. who sugar coat our medical system like it was infallible.
3
And yet, if you resist adding a med or inquire about its effectiveness, necessity, or side effects, you are considered a problem patient.
8
We have an elderly friend who takes a plethora of medications and supplements, including prescriptions from her various doctors, things she gets from vitamin stores, drugs she buys by mail, and medicated skin creams she has her friends bring home from trips to Mexico. Her counter is covered with dozens of bottles and packages, most of which she uses daily.
I wondered if her dizzy spells and blurred vision might be caused by these many pills and teas and whatever, so I asked her if her doctor knew about them. The answer was no - because she knows the doctor will tell her to stop using them, and she thinks they keep her young. And there's the problem.
I wondered if her dizzy spells and blurred vision might be caused by these many pills and teas and whatever, so I asked her if her doctor knew about them. The answer was no - because she knows the doctor will tell her to stop using them, and she thinks they keep her young. And there's the problem.
7
Whenever I am prescribed anything at all, I check it. I check who makes it, how long it's been around, what drug and food interactions one should avoid, and all potential side-effects. I check more than one website since it seems foolhardy to reply solely on the maker of the drug. Occasionally, I have decided to avoid the drug.
However, it wasn't till I needed a new hip and was told about the interactions of NSAIDs and fish oil capsules that I became aware of the many interactions possible when taking supplements. I was glad to know and, by the way, the new hip is a wonder. It's been nine months and I walk around with ease and best of all, no pain!
However, it wasn't till I needed a new hip and was told about the interactions of NSAIDs and fish oil capsules that I became aware of the many interactions possible when taking supplements. I was glad to know and, by the way, the new hip is a wonder. It's been nine months and I walk around with ease and best of all, no pain!
4
I find it odd that many people think it is normal to be taking lots of drugs when one is older. Personally, I dislike the idea of being reliant upon drugs of any sort and am suspicious of doctors who try to prescribe them for me. I do the best I can with eating healthy and living healthy and avoid doctors.
8
Our family has a number of complicated medical conditions. Here’s what I learned:
- Check out like “Best Pills, Worst Pills.” They’re very attentive to common drug interactions, even if they’re a bit more skeptical of big pharma than I am.
- Keep an Excel spreadsheet (or something like it) with medicines prescribed, major medical events, reactions/big symptoms.
- Keep a folder with all your labs and carry it to every different doctor. If they ask if you’ve had a certain tests, voila, there’s the instant answer.
- If you still feel awful after the doctor has said, “this medicine/procedure/etc. is not the problem,” and you think it is that, keep looking for the most respectable alternative medicine input, and fess up to the regular docs that you’re doing so.
- Check out like “Best Pills, Worst Pills.” They’re very attentive to common drug interactions, even if they’re a bit more skeptical of big pharma than I am.
- Keep an Excel spreadsheet (or something like it) with medicines prescribed, major medical events, reactions/big symptoms.
- Keep a folder with all your labs and carry it to every different doctor. If they ask if you’ve had a certain tests, voila, there’s the instant answer.
- If you still feel awful after the doctor has said, “this medicine/procedure/etc. is not the problem,” and you think it is that, keep looking for the most respectable alternative medicine input, and fess up to the regular docs that you’re doing so.
2
I tell my patients, "you need as many meds as you need--no more, but also no less." If a patient has heart disease, hypertension, diabetes, hypothyroidism, depression--they're likely to be on (and benefit from)
aspirin,
an ace-inhibitor
a beta-blocker
metformin
levothyroxine
an SSRI.
That's six meds. Many diabetics are on two or three diabetes meds to control the disease. There could be osteoporosis, so vitamin D and possibly a bone-strengthening med could be useful.
Big pharm, though a big problem in our country, often doesn't enter into this--all the meds for this hypothetical patient would likely be generic (except extra diabetes drugs, which get expensive after the first couple of drugs).
Potential drug interactions can be a big problem, and the answer is often to decrease the number of drugs taken, but that's not always advisable or beneficial. Software is helpful, but there are so many **potential** interactions that deciding which are clinically significant for a patient is often very difficult (e.g., with many "combination pills", which contain two meds, there are interactions between the two meds in the single pill!) Managing this issues is one of the central functions of primary care doctors.
aspirin,
an ace-inhibitor
a beta-blocker
metformin
levothyroxine
an SSRI.
That's six meds. Many diabetics are on two or three diabetes meds to control the disease. There could be osteoporosis, so vitamin D and possibly a bone-strengthening med could be useful.
Big pharm, though a big problem in our country, often doesn't enter into this--all the meds for this hypothetical patient would likely be generic (except extra diabetes drugs, which get expensive after the first couple of drugs).
Potential drug interactions can be a big problem, and the answer is often to decrease the number of drugs taken, but that's not always advisable or beneficial. Software is helpful, but there are so many **potential** interactions that deciding which are clinically significant for a patient is often very difficult (e.g., with many "combination pills", which contain two meds, there are interactions between the two meds in the single pill!) Managing this issues is one of the central functions of primary care doctors.
10
Yeah, but doctors now seem to diagnose EVERYONE with at least 3 of the conditions you mentioned. Also, the benefit from eating healthier and exercise will probably outweigh the effects of all those drugs. It takes 33 people paying the medical industrial complex for statins for 1 person to benefit. All 33 would be healthier if they took a walk outside for 30 minutes a day.
2
Another way to share information with your physician is printing a list of med from from the pharmacy's website.
This article assumes that physicians know more about medications than they actually do.
12
Since 3/27/16, NY physicians now send all presciptions through the Internet. The three chains (Walgreens, Rite Aid, and CVS) have software that does a good job of warning doctors and patients about any and all drug interactions,
The solution to the polypharmacy problem seems simple: patients need to register all over-the-counter, herbal remedies, vitamins, and supplements on-line with their pharmacies. The same excellent drug interaction software can then give all polyphamacy specific warnings.
The solution to the polypharmacy problem seems simple: patients need to register all over-the-counter, herbal remedies, vitamins, and supplements on-line with their pharmacies. The same excellent drug interaction software can then give all polyphamacy specific warnings.
1
Registering OTC meds. and vitamins, supplements, etc., is a terrible idea unless you trust the judgement of the bureaucrats at your insurance company more than you trust your own judgement.
I support HMOs and government-paid health care. I do not support regulation of my health choices by strangers.
I support HMOs and government-paid health care. I do not support regulation of my health choices by strangers.
1
Why didn't this article on polypharmacy mention painkillers? Many older adults take opioids for pain along with their other drugs. So they can be a big part of polypharmacy for individuals. I realize the author may not have wanted to get into the opioid debate on government recommendations, overuse, potential for addiction, etc. But widespread use of opioids must be addressed within the context of the use of multiple drugs, and with the acknowledgement that, like other drugs a person may be taking, dosage, interactions and appropriateness have to be reviewed as a person ages.
6
There are many concerns about overprescription of opioids in all age groups and certainly geriatric patients are more likely to suffer from their side effects especially constipation and sedation.
However, with regard to drug-drug interactions, the major problem is that many commonly prescribed drugs, most notably the SSRI antidepressants, interfere with the metabolism of several of the opioids including hydrocodone and oxycodone. Unfortunately though we've been aware of this for years many doctors are still unaware of this and continue to prescribe these drugs. Patients ending up taking more of the opioid to get the analgesic effects with accompanying exacerbation of side effects.
The other major problem is prescribing opioids and benzodiazepines together. Although benzodiazepines increase the risk of opioid OD deaths and actually interfere with the analgesic effects of opioids, many doctors still prescribe them together.
Finally, many patients taking Vicodin (hydrocodone plus Tylenol) or Percocet (oxycodone plus Tylenol) also take additional over the counter Tylenol with the resulting risk of liver failure.
As a pain management physician I can tell you that these are not theoretical problems but, sadly, very common ones.
However, with regard to drug-drug interactions, the major problem is that many commonly prescribed drugs, most notably the SSRI antidepressants, interfere with the metabolism of several of the opioids including hydrocodone and oxycodone. Unfortunately though we've been aware of this for years many doctors are still unaware of this and continue to prescribe these drugs. Patients ending up taking more of the opioid to get the analgesic effects with accompanying exacerbation of side effects.
The other major problem is prescribing opioids and benzodiazepines together. Although benzodiazepines increase the risk of opioid OD deaths and actually interfere with the analgesic effects of opioids, many doctors still prescribe them together.
Finally, many patients taking Vicodin (hydrocodone plus Tylenol) or Percocet (oxycodone plus Tylenol) also take additional over the counter Tylenol with the resulting risk of liver failure.
As a pain management physician I can tell you that these are not theoretical problems but, sadly, very common ones.
1
Unfortunately, patients have to be their own record-keepers and advocates at every medical visit, be it routine or an emergency. Over the years, I've caught incorrect dosing on prescriptions before I took them to the pharmacy (I believe the pharmacist would have caught this if I hadn't), incorrect eyeglass prescriptions because the doctor wrote on a pad on which the former prescription had "seeped" through, lab results mailed to me and meant for another patient, and bills meant for another patient. Keeping track of multiple medications is just one more job that falls to patients, because the health care system is way too fragmented. Sometimes when I'm hold for a long time with an insurance company, waiting for someone to pick up on the other end and tell me why there's been yet another glitch with a routine claim or why they are asking me for COB information when I don't have other insurance, I jot down pertinent medical information, including RX and OTC medicines. Knowledge is power. And if the system isn't going to help patients gain the knowledge they need, for now patients just have to add one more thing to their ever-growing to-do lists: Make medication lists and update them and keep them handy.
7
The problem with medicine in the USA is the undue influence of Big Ag and Big pharma. Big Ag corporations aggressively market to the public and lobby congress so that the profits from their processed nonnutritious products will continue to flow This way, obesity, hypertension, diabetes and dyslipidemia will continue to increase. This pleases Big pharma, as they have a drug to treat what ails you. A marraige made in heaven. It isnt about getting people actually healthier, but creating a system where health care isnt really health care but a system of distributing drugs
1
And who are two of the biggest donors to the American Diabetes Association? Big Pharma and Big Ag. And what organization continues to in insist on promoting a diet that has too many carbohydrates for diabetics and pre-Type 2 diabetics? The American Diabetes Association.
The ADA, which should be railing against carbohydrates (other than from green veggies), does not. Perhaps they do not want to alienate their big donors.
The ADA, which should be railing against carbohydrates (other than from green veggies), does not. Perhaps they do not want to alienate their big donors.
1
The Carnegie and Rockefeller Foundations began subsidizing the pharmaceutical industry in 1923 and from that point on the pharmaceutical industries and their allies (the AHA, the FDA and the AMA) have been waging a war against all non-toxic alternatives, almost driving.
Natural cures and treatments can be very powerful and superior but have been suppressed here and in many European countries.
Prescription medications are ruining the health of the elderly in particular, often leading even to alcoholism, which is increasing among the elderly.
Currently saturation advertising for them, illegal in every other country, is particularly egregious and harmful.
Doctors and patient alike are uninformed and believe these poisons are "benign".
No wonder in America, where 50% of prescription drugs are consumed, is seeing a decline in life expectancy.
Especially in the case of white women, who take submit to poor medical and nutritional advice, suffer the most in terms of life expectancy.
High tech machines, surgeries. over testing and unnecessary pill prescriptions and procedures are doing more harm than good.
Natural cures and treatments can be very powerful and superior but have been suppressed here and in many European countries.
Prescription medications are ruining the health of the elderly in particular, often leading even to alcoholism, which is increasing among the elderly.
Currently saturation advertising for them, illegal in every other country, is particularly egregious and harmful.
Doctors and patient alike are uninformed and believe these poisons are "benign".
No wonder in America, where 50% of prescription drugs are consumed, is seeing a decline in life expectancy.
Especially in the case of white women, who take submit to poor medical and nutritional advice, suffer the most in terms of life expectancy.
High tech machines, surgeries. over testing and unnecessary pill prescriptions and procedures are doing more harm than good.
1
Yes, alcohol and other drug abuse a big, and growing, problem among older adults. But, I am definitely confused by your assertion that prescription drug use leads to alcoholism. Explanations and citations, please...
Many prescription drugs are highly addictive, much more than is thought.
One of these groups are Benzodiazepams.
These drugs are wonderful if you are wracked with anxiety.......fro a while.
Eventually without them your anxiety becomes greater and greater.
I have four friends I just learned who were at one times addicted to these.
They are 40 per cent more addictive than heroin according to Dr. Mark Harmon.
After about 6 months there is a tipping point where you become physiologically addicted and need larger dosages.
If you cant get them, then you turn to alcohol.
I saw a PBS special on the growing incidence of alcoholism among the elderly. One lady profiled had never even taken a prescription drug before or been much attracted to alcohol, let alone dependent on it.
But when her declining financial status in her old age began to create severe anxiety in her, she turned to the doctors, who gave her the Benzos.
Which led to her alcoholism.
One of these groups are Benzodiazepams.
These drugs are wonderful if you are wracked with anxiety.......fro a while.
Eventually without them your anxiety becomes greater and greater.
I have four friends I just learned who were at one times addicted to these.
They are 40 per cent more addictive than heroin according to Dr. Mark Harmon.
After about 6 months there is a tipping point where you become physiologically addicted and need larger dosages.
If you cant get them, then you turn to alcohol.
I saw a PBS special on the growing incidence of alcoholism among the elderly. One lady profiled had never even taken a prescription drug before or been much attracted to alcohol, let alone dependent on it.
But when her declining financial status in her old age began to create severe anxiety in her, she turned to the doctors, who gave her the Benzos.
Which led to her alcoholism.
2
Unlike prescription drugs, so called "natural remedies" are totally unregulated in the United States, even though many are dangerous, particularly if taken in large quantities without medical supervision. Then there are those over-the-counter substances which are contaminated or even something completely different from what they claim to be. Buyer beware,
1
And then there are the ads on TV. Only the US and New Zealand permit this and the American Medical Association is eager to have it stop. Even with the mandated list of side effects (usually risk or death, in one form or another), and the fact that many of these meds are not better than OTC remedies or mere tweaks on the prescription version that came before, patients ask for them and doctors deliver. It's worth noting that on evening news shows, with an older demographic, these ads run one after the other. They are taking advantage of people of a certain age, raising national health care cots and benefiting, primarily, Big Pharma. (Shame on us.)
10
I'm on about 20 prescriptions a day as a result of a chronic disease coupled with an organ transplant. Post-transplant (12 years ago) I decided to use just one pharmacy and their computer has caught more than one problematic interaction that slipped by my doctor. Using just one pharmacy is about the best piece of advice I can give anyone who has to juggle a number of meds.
36
Sometimes journalists do a good job of reporting on medical findings; sometimes not.
On the problem of amlodipine and simvastatin, using another blood pressure med is not the best medical advice; African Americans have been found to be more responsive to calcium channel blockers e.g. amlodipine aka norvasc. So I would try to find a statin alternative. A quick look at my cell phone epocrates app finds no interaction between amlodipine and atorvastatin; this is reasonable since atorvastatin is much less likely to cause muscle injury. So I hope readers will not want to abandon their amlodipines; it's not necessary and may lead to less effective alternatives.
I am a primary care doc and I always ask patients to come to every visit with all their current med bottles, insulins. I also ask them to get all their meds at one pharmacy; pharmacies also have software to check on drug interactions.
Although there are privacy concerns, a software, common to all providers, would be so helpful in coordinating patient are. It is time consuming and tiresome to keep asking for other records.
I do decry the advertising of expensive meds to the public and to physicians. I think back to my Sunday school lessons on how Jesus threw out all the money changers from the temple. That's how I feel when drug reps takeover our lunch room to hawk their wares. They cheapen our clinic, making it just a place to find consumers.
On the problem of amlodipine and simvastatin, using another blood pressure med is not the best medical advice; African Americans have been found to be more responsive to calcium channel blockers e.g. amlodipine aka norvasc. So I would try to find a statin alternative. A quick look at my cell phone epocrates app finds no interaction between amlodipine and atorvastatin; this is reasonable since atorvastatin is much less likely to cause muscle injury. So I hope readers will not want to abandon their amlodipines; it's not necessary and may lead to less effective alternatives.
I am a primary care doc and I always ask patients to come to every visit with all their current med bottles, insulins. I also ask them to get all their meds at one pharmacy; pharmacies also have software to check on drug interactions.
Although there are privacy concerns, a software, common to all providers, would be so helpful in coordinating patient are. It is time consuming and tiresome to keep asking for other records.
I do decry the advertising of expensive meds to the public and to physicians. I think back to my Sunday school lessons on how Jesus threw out all the money changers from the temple. That's how I feel when drug reps takeover our lunch room to hawk their wares. They cheapen our clinic, making it just a place to find consumers.
18
The whole system is broken. Big pharma has dictated drug use for decades by marketing first to doctors and now on media (TV, Magazines). If you listen or read the ads you have to be crazy to take many of these drugs since the potential side effects are worse than what the drugs are intended to treat. It is a travesty that so many people are taking so many drugs. And I wonder how many deaths have been caused by drug interactions or the drugs themselves.
4
The only way to end the scourge of polypharmacy and the opioid overdose epidemic is to take away the huge profits gained by pumping people full of medicine they don't need.
3
Excellent article. As a community health nurse, I encourage my patients to bring their medications in for a brown bag review. I have encountered several patients who were doubling up on medication without realizing it. I'm a big fan of pill holders, to help patients organize and remind them to take their medications. Medications regimens are complicated, and anything that helps keep patients on track and safe is great.
5
At every Dr. visit, regardless of specialty, all meds and supplements should be revealed by history and asking about OTC meds and herbs. Over age 75, aspirin is seldom indicated, even 81 mg. Falls are more dangerous for those on aspirin, if the head is struck since aspirin inactivates platelets which are the first line of defense in bleeding. Omega 3+6 oils have no known benefit unless there is known cardiac disease. All meds should be counted out a week in advance and placed into a counter with compartments. The primary care Dr./internist must coordinate all meds and not shrug off meds that are ordered by a specialist as "not my concern" and communication with other Drs. must take place in the presence of suspected conflict. Where one med will do, two should not be ordered, etc. to avoid numerous and unpredictable drug interactions. Pharmacologic knowledge should neither start nor end with the drug rep. Drs. must consult with texts, PDR, the internet to stay current. New drugs must be prescribed with caution, side effects are often reported as post marketing data by and to the FDA. Few herbs have known benefit, but some are quite powerful.
16
How likely is it that doctors will "consult" with texts, the PDR and the internet to stay current?
1
"Not all are imperiled by polypharmacy, of course.”
And there it is. After planting it’s usual seed of hysteria, the Times issues it’s standard disclaimer. Buried deep in the story as usual.
The sun never sets on the NYTimes anti med agenda.
And there it is. After planting it’s usual seed of hysteria, the Times issues it’s standard disclaimer. Buried deep in the story as usual.
The sun never sets on the NYTimes anti med agenda.
3
The problem is greatly aggravated by the problem ofhealth insurance paying for prescription drugs. in this envronment, Doctors expect that patients expect a prescription as the natural product of a doctor's visit, ans so he obliges with the notion that it may do some good.
If the patient was paying for all his prescriptions, he would ask his doctor "Doc, do I really need this prescription because I am already taking A, B and C and it's about all I can afford." And the Doctor, who otherwise might not even be aware of the other prescriptions (a defect in the system of medical records which may be fixed, might actually use his brain to make a judgment call about which drugs are likely to really provide a benefit.
If the patient was paying for all his prescriptions, he would ask his doctor "Doc, do I really need this prescription because I am already taking A, B and C and it's about all I can afford." And the Doctor, who otherwise might not even be aware of the other prescriptions (a defect in the system of medical records which may be fixed, might actually use his brain to make a judgment call about which drugs are likely to really provide a benefit.
3
Individuals vary considerably. As many as 75% of patients don't take their medications as prescribed, and the additional variable of taking or not taking ever-increasing numbers of prescribed medications only muddies the waters.
I am at the bottom edge of polypharmacy and "older adults". My specialists will prescribe drugs for me, but renewals pass, reasonably, through my family practitioner. He (in this case, a he) is very alert to additions and changes (in part a result of electronic medical records), and he won't renew a drug without a visit with him or my specialists, unless it is pro-forma. I'm happy that I have such an alert physician (and my health-care add-on to Medicare also monitors the situation, but annoyingly sends me paper documents to summarize my drugs).
I am a denizen of the internets, and keenly aware of drug interactions and side-effects. That behavior varies tremendously among people my age, and many ages. I take warfarin, and it basically means that I shouldn't use herbals, and most OTC drugs, at least not without checking on the internets, or with my general physician. My naive experimentation with all things herbal in my "youth" has narrowed to a multivitamin and an occasional fish oil capsule. And green papaya salad for lunch every day is out.
The article suggests some general solution, and there are some procedures that work well, as I've described. But your health is your concern, so you must manage it carefully.
I am at the bottom edge of polypharmacy and "older adults". My specialists will prescribe drugs for me, but renewals pass, reasonably, through my family practitioner. He (in this case, a he) is very alert to additions and changes (in part a result of electronic medical records), and he won't renew a drug without a visit with him or my specialists, unless it is pro-forma. I'm happy that I have such an alert physician (and my health-care add-on to Medicare also monitors the situation, but annoyingly sends me paper documents to summarize my drugs).
I am a denizen of the internets, and keenly aware of drug interactions and side-effects. That behavior varies tremendously among people my age, and many ages. I take warfarin, and it basically means that I shouldn't use herbals, and most OTC drugs, at least not without checking on the internets, or with my general physician. My naive experimentation with all things herbal in my "youth" has narrowed to a multivitamin and an occasional fish oil capsule. And green papaya salad for lunch every day is out.
The article suggests some general solution, and there are some procedures that work well, as I've described. But your health is your concern, so you must manage it carefully.
1
Good article /discussion. Food for thought. Are the supplements we take hurting more than they're helping? lots of claims. little proof. One thing for sure. i'm going to look at them more critically now and start cutting back. make the Missus happy and probably save a few bucks too. so hard to regulate without overregulating.
Lots of claims, zero proof actually.
Polypharmacy is not necessarily bad. In fact, certain combinations of supplements and traditional pharmaceuticals can create a positive synergistic effect depending on what you are trying to treat or whether you're taking such combinations for preventative purposes.
I think the issues more about some close-minded doctors feeling threatened by better informed patients who are willing to do the research that many doctors are too lazy to do themselves. Shared decision making is here to stay and will become more prevalent as patients become more educated in taking a more active role in their own healthcare.
I think the issues more about some close-minded doctors feeling threatened by better informed patients who are willing to do the research that many doctors are too lazy to do themselves. Shared decision making is here to stay and will become more prevalent as patients become more educated in taking a more active role in their own healthcare.
1
I agree. I was prescribed metformin due to diabetes by my primary care provider, a MD. It took a naturopath to check my vitamin B 12 levels, which can be decreased by metformin, to find out it was low. I'll be receiving B 12 injections as I am deficient Glad I found out...probably have prevented neuropathy, and other damaging side effects from low B 12.
2
If only doctors could direct their parents to change their behaviors and lifestyles. Eating more plant-based whole foods and exercising could potentially reverse type II diabetes, lower blood pressure, and do wonders for the heart and energy levels. For older adults, polypharmacy is part of a vicious cycle. An older adult takes too many medications, which very likely leads to falls. The fall leads to hospitalization. Hospitalization leads to debility. More medications are prescribed. Vicious cycle never ends.
Recently, I tried out a new dermatologist. Seconds into the initial evaluation, her assistant prepares a needle filled with cortisone. Before I knew it, the assistant injected my adult acne spots with the cortisone. The dermatologist prescribes four medications. I left the visit confused. What just happened? Not once did this doc touch my skin or address my real concerns.
Instead of using the medications, I drank more water, ate more fruits and greens, and washed my face with Cetaphil. It's working out great.
PS to the trolls: I'm a doctor of physical therapy and a certified lymphedema therapy who will soon earn an academic doctorate. So I will continue to proudly display my name as Dr. Kat Lieu.
Recently, I tried out a new dermatologist. Seconds into the initial evaluation, her assistant prepares a needle filled with cortisone. Before I knew it, the assistant injected my adult acne spots with the cortisone. The dermatologist prescribes four medications. I left the visit confused. What just happened? Not once did this doc touch my skin or address my real concerns.
Instead of using the medications, I drank more water, ate more fruits and greens, and washed my face with Cetaphil. It's working out great.
PS to the trolls: I'm a doctor of physical therapy and a certified lymphedema therapy who will soon earn an academic doctorate. So I will continue to proudly display my name as Dr. Kat Lieu.
5
A facial cleanser containing sulphur could also help your acne.
I'm reluctant to take drugs except after a surgery (recent broken wrist). I take a low dose statin and that's it, unless you include a calcium pill with Vitamin D. I've worked in health care so am fixated on avoiding the polypharmacy I've seen in many people. Many conditions, even at our age, can be self-limiting. Daily stretches and exercise are my drugs of choice.
8
I have added vitamin K2 to my regime as the evidence seems to support adding this to vitamin D3 and calcium. It appears to help the calcium be routed to the bones and not arteries.
Here is the evidence:
http://www.ncbi.nlm.nih.gov/pubmed/26452518
http://www.ncbi.nlm.nih.gov/pubmed/23109511
Unfortunately I found about K2 on a facebook post and not from my MD.
PubMed is the repository for medical research. Enjoy!
Here is the evidence:
http://www.ncbi.nlm.nih.gov/pubmed/26452518
http://www.ncbi.nlm.nih.gov/pubmed/23109511
Unfortunately I found about K2 on a facebook post and not from my MD.
PubMed is the repository for medical research. Enjoy!
1
This is what's going to happen here in America soon: http://www.psychiatrictimes.com/blogs/couch-crisis/physician-assisted-dy...
When I was so iatrogenically ill from being poly-drugged with psychiatric medicine for 35 years, I attempted suicide no less than 15 times, 2 resulting in a coma. I was constantly trying to escape the constant side effects, adverse effects and the mentally torturous withdrawal symptoms that psychiatrist's or mental healthcare workers never, ever informed me of. And at that time had my doctor offered to 'euthanize' me to end my ongoing psychiatric drug induced suffering I would have paid him/her to do it. Is this what they mean by depopulation?
When I was so iatrogenically ill from being poly-drugged with psychiatric medicine for 35 years, I attempted suicide no less than 15 times, 2 resulting in a coma. I was constantly trying to escape the constant side effects, adverse effects and the mentally torturous withdrawal symptoms that psychiatrist's or mental healthcare workers never, ever informed me of. And at that time had my doctor offered to 'euthanize' me to end my ongoing psychiatric drug induced suffering I would have paid him/her to do it. Is this what they mean by depopulation?
3
I think the bad effects of polypharmacy can be seen best in how psychiatry has prescribed,especially in the past 30 years,as Whitaker in "Anatomy of An Epidemic" has shown. And how they continue to routinely prescribe "cocktails" of up to 5 medications after a 15 minute consultation. Harmful,often addictive medications that give short-term gain with poor long-term outcomes. Therapy and social support,and time, with natural therapies, much better to promote true healing. The truth is slowly coming out. Too bad a person sometimes in a desperate and vulnerable state encounters mainstream psychiatriy.
4
We need to fix our medical system so that all of a person's records can be found within ONE central database for any/all doctors to open up and reference.
And yes, doctors need to ask the question, and patients need to also inform their doctors, about all remedies taken on a regular basis.
While surely 'natural remedies' can also have interactions and side effects, I'd take a doctor's poo-poo'ing such remedies with a grain of salt. Doctors aren't exactly visited each week by 'natural' or 'alternative' remedy sales reps, with free 'samples' or coupons to give out to their patients. lol
And yes, doctors need to ask the question, and patients need to also inform their doctors, about all remedies taken on a regular basis.
While surely 'natural remedies' can also have interactions and side effects, I'd take a doctor's poo-poo'ing such remedies with a grain of salt. Doctors aren't exactly visited each week by 'natural' or 'alternative' remedy sales reps, with free 'samples' or coupons to give out to their patients. lol
6
Per capita, Americans take more meds than any other population on the planet and of course the cost is the highest. It is astonishing how little patients question their providers as to the risks and benefits and as a society how we let the pharmaceutical industry bamboozle and corrupt our politicians.
10
Brava ! , Paula Span
I'm 76 and take NO meds.
I challenge every physician "offering", eat a balanced diet, exercise my body & brain, don't smoke, do drink in moderation & have a social support system.
So many of my friends indulge in "polypharmacy" & I'm frequently suggesting, gently I think, they ask their physician to do a med "review".
I think sometimes, prescriptions are equated with loving & caring.
I'm 76 and take NO meds.
I challenge every physician "offering", eat a balanced diet, exercise my body & brain, don't smoke, do drink in moderation & have a social support system.
So many of my friends indulge in "polypharmacy" & I'm frequently suggesting, gently I think, they ask their physician to do a med "review".
I think sometimes, prescriptions are equated with loving & caring.
31
Good for you Beatrice and I assume you're going to be the one person in history who lives forever.
Yes lifestyle is important but their are many other factors involved in disease such as genetics, over which we currently have little control, and environment, which if you are in the top 1% you may be able to control but which most people have little control over.
Yes lifestyle is important but their are many other factors involved in disease such as genetics, over which we currently have little control, and environment, which if you are in the top 1% you may be able to control but which most people have little control over.
You rule, way to be :-) You contrast so much with the commenter above you that is like "Go Away, leave me to the addiction my doctors enable for me". I'd rather get older like you, instead of getting old in a fog of opiates and Xanax.
1
Thank you for this very important and fair article. In addition to the issue of polypharmacy, it is a relief to finally see some critical discussion of so-called "natural" or "herbal" products or "dietary supplements". While I'm no great fan of the pharma industry, at least their products are carefully tested for toxicity, efficacy, interactions with other medications, and the exact dosage is determined for various patient weights, ages, gender, etc. The tests required to get a drug approved by the FDA are challenging, and we can all be thankful for the rigorous standards set by the FDA. I wish that the same standards were applied to all the so-called "natural" products and supplements.
3
Eddie, you are aware that of how doctored up, altered and falsified the results are for the clinical studies regarding safety and efficacy are aren't you? The FDA is so far in bed with big pharma that we will never be told the truth about pharmaceutical drugs. Have you watched 'Secrets of Seroxat'? How about 'Vaxxed'? Or The Truth about Cancer (treatment) documentaries? May I suggest 'Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare' by Peter Gotzsche. This is the year of 'awareness'. I hope you too are able to open your eyes. God Bless you.
2
Are you aware that drugs granted expedited approval haven't completed clinical trials - and sometimes never do (The FDA requires post-approval trials)? And that trials conducted overseas are often problematic, o say the least?
There are many more reasons for concern about drug company studies and FDA, including that a drug may have minimal benefit (Read up on what oncologists are trying to do about this, and drug prices).
There is no efficient mechanism for monitoring and modifying inserts when side effects occur after a drug has been approved. Sure, black box warnings occur, but there is a much larger issue, e.g., do you know which OTC meds you're taking increase the likelihood of Alzheimers? This is proven science, not some alternative theory.
Finally, if Pharma has its way. 21st Century Cures will be approved, which will allow approval of additional indications based upon anecdotal evidence.
So, no FDA approval is not the be all and end all.
There are many more reasons for concern about drug company studies and FDA, including that a drug may have minimal benefit (Read up on what oncologists are trying to do about this, and drug prices).
There is no efficient mechanism for monitoring and modifying inserts when side effects occur after a drug has been approved. Sure, black box warnings occur, but there is a much larger issue, e.g., do you know which OTC meds you're taking increase the likelihood of Alzheimers? This is proven science, not some alternative theory.
Finally, if Pharma has its way. 21st Century Cures will be approved, which will allow approval of additional indications based upon anecdotal evidence.
So, no FDA approval is not the be all and end all.
1
Weird. I have taken everything mentioned for many decades. Now 87.
No aches or pains and a full golf swing.
Wife has gone through various fly and cold systems, arthritis, blood pressure, Colin issues in the bed next to me.
I fly often, exposing myself. No problem.
Why? Tackle box full of 40 pills plus the Rx drugs mentioned.
Maybe, the writer needs to take a second look.
No aches or pains and a full golf swing.
Wife has gone through various fly and cold systems, arthritis, blood pressure, Colin issues in the bed next to me.
I fly often, exposing myself. No problem.
Why? Tackle box full of 40 pills plus the Rx drugs mentioned.
Maybe, the writer needs to take a second look.
Another way the amber bottles stack up is when a person goes in the hospital and gets more discharge prescriptions--the continuity between venues (say hosp and home) is notoriously shaky--and patients get home with a fistful of scrips and it's unclear--take instead of the old stuff, in addition to...what? Also it's hard to know what instructions mean sometimes--take three times a day--during daylight hours, every 8 hrs incl at night? Older people absorb meds less efficiently--or sometime too efficiently...I have heard older people should not take "timed release"--the body cannot break it down as intended. There is a lot in this story...good job.
2
Many writers here extoll the value of supplements. While I agree some might be helpful, the woeful lack of regulation makes them a problem. It's very possible that they don't contain what they say they do, and often the dosage is nothing close to what's claimed on the label. There was an article in the nytimes that reported tests on supplements showing they sometimes contained grass clippings and not the drug they claimed.
Those who argue for the use of supplements would do society a favor if they supported more regulation of them. Orrin Hatch has protected the supplement industry (and it's huge) from regulation; we need to fight this and allow the FDA to regulate supplements to weed out the useless ones and standardize dosages on the useful ones.
Those who argue for the use of supplements would do society a favor if they supported more regulation of them. Orrin Hatch has protected the supplement industry (and it's huge) from regulation; we need to fight this and allow the FDA to regulate supplements to weed out the useless ones and standardize dosages on the useful ones.
63
As a 77 year old senior, I would urge seniors and/or their caretakers to constantly monitor the continuing necessity and potential interactions of prescribed medications.
Supplements manufacturers can and do make outrageous claims of miracles since their claims and their supplements are unregulated by the FDA. Most doctors will tell you that supplements can have major negative interactions with prescription meds and should only be taken if their claims can be verified by prestigious medical journals.
Prescription medicine discoveries have dramatically increased the life expectancy of seniors. Naturally, that has led to an increase in the number of prescribed medications many seniors take.
Pay attention! YOU are responsible for what you put into your body and mind.
Supplements manufacturers can and do make outrageous claims of miracles since their claims and their supplements are unregulated by the FDA. Most doctors will tell you that supplements can have major negative interactions with prescription meds and should only be taken if their claims can be verified by prestigious medical journals.
Prescription medicine discoveries have dramatically increased the life expectancy of seniors. Naturally, that has led to an increase in the number of prescribed medications many seniors take.
Pay attention! YOU are responsible for what you put into your body and mind.
3
This is an important issue but needs to also consider several critical points: 1) while many drugs have been identified because of potentially harmful interactions when co-prescribed, there is also the potential for reduction of efficacy resulting from their combination, 2) no patient ever presents to a physician with "one disease", whether they have been treated, are under treatment, or not yet diagnosed, so co-morbidities and poly-pharmacy are the rule, not the exception, 3) clinical guidelines, developed by professional societies, rarely anticipate the issues of co-morbid conditions, especially at their actual level of incidence/prevalence, 4) clinical trials focus on recruitment of patients that do not reflect the complexity of real world patients to optimize the potential for successful response and this results in inadequate labelling restrictions, 5) physicians, even when complete patient histories are available, can and do prescribe for the condition being presented and not the "whole patient". Of course, all this is further compounded by the advertisement, access and consumption of non-prescription, and sometimes food, items.
28
You're wrong about #3. Most professional guidelines do take into account comorbid conditions and the use of other drugs in their recommendations.
A great deal of the blame for polypharmacy lies squarely on us older folk. Our goal should be to eliminate or drastically reduce the need for medications by making life style changes and resisting taking medications if there are alternatives. But this requires effort and will power and, yes, enduring some discomfort. At the end of the day you are the one responsible -- for your body, your health choices.
12
Polypharmacy is the future. Until Medicine can cure and not just treat hypertension, hyperlipidemia, diabetes, GERD, arthritis and other chronic afflictions usually of old age but not always, people will be taking more and more pills. The numbers will go up, not down. Polypharmacy is the future. Get used to it.
6
Reviewing medications to see if there are possible adverse interactions is, of course, important. But there are limitations to what such a review can accomplish. Sure it can tell you if Drug A and Drug B taken together may cause a problem. But it can't tell you if Drug A, Drug B and Drug C taken together will harm you. And if you're taking 8 medications (maybe in addition to vitamins and other supplements) how do you know if these drugs in the aggregate are not causing you harm? There's no proof, but my best guess is taking multiple drugs is probably detrimental to your overall health, maybe causing mental problems, maybe autoimmune reactions, maybe shortening, not lengthening your life span.
Doctors are a huge part of the problem. Mention any health issue and they'll suggest a drug. If I had listened to my doctors I could easily be taking six drugs/supplements right now, and I don't have any major health problems. Also, as many people have mentioned, the drug ads don't help.
Doctors are a huge part of the problem. Mention any health issue and they'll suggest a drug. If I had listened to my doctors I could easily be taking six drugs/supplements right now, and I don't have any major health problems. Also, as many people have mentioned, the drug ads don't help.
10
Ms. Span, Thank you for writing an informative article. Improper use of medications wastes an estimated (IMS Health) US$300B annually. Even more important, an estimated 125,000 people die each year from preventable adverse drug events. Significant harm comes from improper use of medications. This not only includes polypharmacy, but also the wrong amount or frequency of medication, the wrong medication altogether and an even bigger problem is not taking the medication as prescribed. The latter referred to as non-adherence. A handful of factors play into these preventable causes of harm and financial waste. These include socioeconomic factors (chronic condition medications can be expensive), behavior (habits are tough to beat as Duhigg so well articulates), beliefs about medications, physical or mental impairment and an ever present lack of coordination among the many providers of care, as the opening paragraphs of Span's article tells. A proven solution to this has been demonstrated at Community Care of North Carolina year after year - a solution where nearly all care providers across the entire state are sharing data and coordinating care plans. The health profession knows this is an answer, evidenced by the rapid rise of Patient Centered Medical Homes. Cost of care though has stymied the proliferation of such practices. That though can be solved - my company has done this - with predictive data analytics, ensuring the care is focused (dollars spent) where it has impact.
2
I'm surprised. Every one of my and my wife's doctors begin every single appointment with a total medication review including all OTC pills and supplements, updating their computer records as we go. All of their computers automatically check (I've asked) for drug interactions. Dosage reductions and/or elimination of particular drugs are regularly directed. Everyone (including nurses) appears fully aware of the Beers criteria *and their updates*. Anti-cholinergics are reduced or replaced.
Do we live on a special medical island where providers do things right? I can't believe it. And the combination of Amlodipine and Simvastatin is, I am told by them, perfectly acceptable *if* the patient can tolerate it without a hint of rhabdomyolysis. Yes, it's polypharmacy. But medicine can now treat many more conditions than could previously be addressed, elderly people do frequently suffer from several chronic conditions at the same time, and rather than ignore serious, ongoing, perpetual illnesses, polypharmacy is called for and appropriate.
Nor should seniors be treated like infantile idiots incapable of following, understanding and regulating their own healthcare, as is all too frequently the case on the part of well-meaning but overbearing adult children who think they know better. In other words, there are many people for whom the sky is not falling. Tone down the chicken little, please.
Do we live on a special medical island where providers do things right? I can't believe it. And the combination of Amlodipine and Simvastatin is, I am told by them, perfectly acceptable *if* the patient can tolerate it without a hint of rhabdomyolysis. Yes, it's polypharmacy. But medicine can now treat many more conditions than could previously be addressed, elderly people do frequently suffer from several chronic conditions at the same time, and rather than ignore serious, ongoing, perpetual illnesses, polypharmacy is called for and appropriate.
Nor should seniors be treated like infantile idiots incapable of following, understanding and regulating their own healthcare, as is all too frequently the case on the part of well-meaning but overbearing adult children who think they know better. In other words, there are many people for whom the sky is not falling. Tone down the chicken little, please.
23
Apparently I, too, live on your island! I see multiple specialists for chronic health problems and they ALL insist on going over every single med...and this is after the intake nurse has already done this and entered any changes in the computer.
My father in law died 15 years ago and saw a physician my late husband and I called "Dr Feelgood" as she prescribed for everything and te again fir the side effects caused by these meds. His 92 yr old after was on 20 different meds at the time of his death, including sleeping pills, laxatives, and multiple diuretics, as well as heart meds and you name it. Many of these drugs can cause falls in the elderly and they did for him.
But much of this was his own fault as he wanted a pill for everything and refused to make any lifestyle changes.
All I can say is if your doctor isn't asking, change from doctors, and yes, it IS his business what OTC meds you're taking as well as all the supplements your chiropractor suggested you take.
My father in law died 15 years ago and saw a physician my late husband and I called "Dr Feelgood" as she prescribed for everything and te again fir the side effects caused by these meds. His 92 yr old after was on 20 different meds at the time of his death, including sleeping pills, laxatives, and multiple diuretics, as well as heart meds and you name it. Many of these drugs can cause falls in the elderly and they did for him.
But much of this was his own fault as he wanted a pill for everything and refused to make any lifestyle changes.
All I can say is if your doctor isn't asking, change from doctors, and yes, it IS his business what OTC meds you're taking as well as all the supplements your chiropractor suggested you take.
5
Several years ago when my mother in law was very ill, she saw several specialists in addition to her regular internist. All of them did a medication review at every appointment but what made this difficult was the fact that each physician didn't have access to the medical records of the other two physicians that she was seeing. I can see where this lack of communication could make polypharmacy and drug allergies a real problem. We overcame this by hand carrying an updated homemade medical record to each and every appointment.
7
....... and electronic medical records do not always help, since some healthcare mergers guard their "turf" and decline to share with other hospital organizations or charge prohibitive fees.
2
Polypharmacy is the result of two child-like attitudes: First, the hope that magic pills will make up for poor diet and senesce. Perhaps worse, it follows from a passive willingness to get on the conveyor belt of the Medical Industrial Complex, which of course, is more than happy to oblige not just with endless drugs, but tests, surgeries and medical devices.
26
I'll say it again: patients should not surrender autonomy or do what they're told by a profession that is warped by the process that produces doctors. The dependency on specialists makes the whole situation worse, as they never communicate with each other and primary doctors ain't what they used to be.
So I'm trying to keep care within one hospital, where my records are always available, even if I forget.
So I'm trying to keep care within one hospital, where my records are always available, even if I forget.
12
Another complicating factor to this problem is price shopping among frugal consumers.
If my elderly mother would fill all of her prescriptions at one central pharmacy, at least theoretically, this would allow for automated identification of contraindicated drugs and thus allow the pharmacist the chance to advise her and her doctor of the risk.
Instead she insists on driving all over town to chase the lowest price or best deal on each of her myriad drugs for high cholesterol, high blood pressure, rheumatoid arthritis, macular degeneration and on and on and on...
Ironically it is the help line operator for her Part D coverage who frequently tells her which pharmacy provider offers the best price on a given drug thus validating her crazy patch work approach to filling her prescriptions.
This ridiculous exercise saves her (and many many others) probably a few hundred dollars a year--less when you factor in the added expense of all the shopping around. Although beneficial on a micro level (sort of) I wonder what the aggregate hospitalization and associated costs are for treating the sometimes deadly effects of dangerous drug interactions?
My guess is that there are two winners in this deeply broken system; 1) big pharma and 2) insurance companies.
If my elderly mother would fill all of her prescriptions at one central pharmacy, at least theoretically, this would allow for automated identification of contraindicated drugs and thus allow the pharmacist the chance to advise her and her doctor of the risk.
Instead she insists on driving all over town to chase the lowest price or best deal on each of her myriad drugs for high cholesterol, high blood pressure, rheumatoid arthritis, macular degeneration and on and on and on...
Ironically it is the help line operator for her Part D coverage who frequently tells her which pharmacy provider offers the best price on a given drug thus validating her crazy patch work approach to filling her prescriptions.
This ridiculous exercise saves her (and many many others) probably a few hundred dollars a year--less when you factor in the added expense of all the shopping around. Although beneficial on a micro level (sort of) I wonder what the aggregate hospitalization and associated costs are for treating the sometimes deadly effects of dangerous drug interactions?
My guess is that there are two winners in this deeply broken system; 1) big pharma and 2) insurance companies.
24
You raise an extremely important point.
4
This problem also occurs when you are encouraged by your pharmacy plan to use their mail order "service" for your maintenance meds. If you need medication for an acute problem you must go to a local pharmacy which has none of your maintenance meds in your record. And no pharmacy that I have used has been able to add my supplements to my pharmacy records so they can be taken into account in checking for interactions.
6
..... and I find that hospitals & pharmacies fail to delete the meds in which dosages have been changed and/or discontinued.
I agree with the primary purpose of this article: To have patients inform their PCP of all medications/supplements that they are taking to prevent possibly harmful interactions. BUT where I draw the line is the doctors' statements regarding the uselessness, poor regulation and potential dangers of supplements. Conventional, allopathic doctors often know far less about natural supplements than their patients who consume them. There are many alternatives to conventional medications which, by the way, often do little more than mask symptoms. Furthermore, so many of these drugs are FAR more dangerous than supplements. Finally, and most importantly, it behooves the medical establishment to study the tremendous benefits of natural supplementation for serious diseases which in some cases counteract the serious side effects of drugs. One example: Co Q 10 is an extremely important nutrient for cardiovascular health, particularly in seniors. Ironically the Statins that are prescribed to so many heart patients deplete their levels of co q 10. I had advised my mother to take CO Q 10, but her doctor advised her to stop taking it. When asked why, his response was "I don't know anything about it." In this case, honesty is hardly enough.
8
"BUT where I draw the line is the doctors' statements regarding the uselessness, poor regulation and potential dangers of supplements. Conventional, allopathic doctors..."
As a conventional allopathic doctor I will agree we should not just dismiss supplements as useless - but absolutely they are *poorly* regulated and have *potential* dangers. The greatest I think is false security.
I practice in a very naturopath-happy community and people here are generally very fit, very active (FYI, my location above is old and incorrect). I work in a hospital setting only and see people in bad times, it is not rare - in fact it is common - for people to develop what is a concerning sign or symptom and/or receive a straight up diagnosis (cancer) and turn to their naturopath due to their feelings towards the establishment medicine. I then see them in the late stages of overwhelming disease, often with no shot of cure since they relied on salves and herbs for months, and now it has spread to levels I cannot reverse despite all of the best technology available. It is heartbreaking to watch, I promise.
There is room for both approaches to healthcare and certainly the scientific allopathic MD's need to look at the science and not just the status quo about many, many medications. Everything in moderation and I assure you, must of us docs are out to help patients, not drug companies.
Fear of litigation however is very real.
As a conventional allopathic doctor I will agree we should not just dismiss supplements as useless - but absolutely they are *poorly* regulated and have *potential* dangers. The greatest I think is false security.
I practice in a very naturopath-happy community and people here are generally very fit, very active (FYI, my location above is old and incorrect). I work in a hospital setting only and see people in bad times, it is not rare - in fact it is common - for people to develop what is a concerning sign or symptom and/or receive a straight up diagnosis (cancer) and turn to their naturopath due to their feelings towards the establishment medicine. I then see them in the late stages of overwhelming disease, often with no shot of cure since they relied on salves and herbs for months, and now it has spread to levels I cannot reverse despite all of the best technology available. It is heartbreaking to watch, I promise.
There is room for both approaches to healthcare and certainly the scientific allopathic MD's need to look at the science and not just the status quo about many, many medications. Everything in moderation and I assure you, must of us docs are out to help patients, not drug companies.
Fear of litigation however is very real.
3
I think your mom should find a new doctor.
1
Many people are also taking many supplements. Your liver cannot metabolize all of these vitamin supplements.
5
Some supplements support the liver (Milk thistle, for example.) Many medications tax your liver.
5
Milk thistle has been used as a cytoprotectant for the treatment of liver disease, for the treatment and prevention of cancer, and as a supportive treatment of Amanita phalloides poisoning. Clinical studies are largely heterogeneous and contradictory.
So why bother ?
So why bother ?
1
I find it interesting that, once again, vitamins and supplements become the problem, even though there are, according to an article from Harvard University, approximately 328,000 deaths per year from drugs in the US and Europe. I have been unable to find any deaths attributed to those "unregulated" vitamins and supplements.
My husband takes a cholesterol lowering drug and CoQ10, a supplement I suggested to his doctor (who said, "I guess it wouldn't hurt"). In Canada, patients who are prescribed cholesterol lowering drugs are advised to take CoQ10 because they know it is necessary.
Each of our physicians asks for a list of ALL prescription and vitamins and supplements at each visit. I was surprised that not all physicians do.
The "possible" reactions of vitamins and supplements do not scare me nearly as much as the "possible" reactions of any and all of the prescription drugs on the market. But patients are continuing to be prescribed multiple drugs for many conditions which could and should be controlled by other methods because it is easier to pop those pills?
Why make supplements and vitamins the villain, along with a decent diet, instead of the prescription drug industry and physicians who are too busy (because of our rigged healthcare system) to take the time to instruct their patients on the dangers of their prescription meds versus taking better care of their own bodies?
My husband takes a cholesterol lowering drug and CoQ10, a supplement I suggested to his doctor (who said, "I guess it wouldn't hurt"). In Canada, patients who are prescribed cholesterol lowering drugs are advised to take CoQ10 because they know it is necessary.
Each of our physicians asks for a list of ALL prescription and vitamins and supplements at each visit. I was surprised that not all physicians do.
The "possible" reactions of vitamins and supplements do not scare me nearly as much as the "possible" reactions of any and all of the prescription drugs on the market. But patients are continuing to be prescribed multiple drugs for many conditions which could and should be controlled by other methods because it is easier to pop those pills?
Why make supplements and vitamins the villain, along with a decent diet, instead of the prescription drug industry and physicians who are too busy (because of our rigged healthcare system) to take the time to instruct their patients on the dangers of their prescription meds versus taking better care of their own bodies?
16
Here in America pharmaceutical drugs is the 3rd leading cause of death. Scientist Peter Gotzsche's book 'Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare' explains it to me very clearly. And I'm appalled that my Medicare & Medicaid only covers Dr's who's only recourse of medical or psychiatric help is prescribing drug after drug after drug. It does not cover a Nutritionalist or Holistic Health and living on Disability this is a major problem for me. Psychiatry has drugged me using over 75 toxic medications that I barely lived through so where do I go from here? I certainly am done relying on what is referred to as 'modern medicine'. That almost killed me. Thank you for your comment SRothgarn. I know why healthy eating, vitamins & supplements are not promoted in this country. It's because Big Pharma isn't able to profit from it - yet.
I specialize in working with Seniors using Medicare. As part of my working with Medicare, even as a Psychologist, I have to ask clients for all Medications and Supplements and review at each visit! I am supposed to get the list from the physicians, but my clients tell me "My physician doesn't know all that I take so you will have to get the more accurate list from me." Oftentimes, clients don't know why they are taking the multiple meds. They haven't been reviewed. I usually recommend they take their list and any new meds to their pharmacist since most physicians have a hard time knowing or keeping up with the constantly changing information on meds. Personally, I take no pharmaceuticals, but take many supplements from reputable companies (which are out there). It is more expensive.
I agree with lifestyle changes but sometimes meds are necessary. Helping clients be informed of the risks and the reasons for taking the meds (in writing). Going to doctors can be stressful. Have someone go with you to take good notes and make sure you get your questions (which should be written down) asked. Or record your visits. The stress and rush of the visit often makes it difficult for clients to remember, even younger, cognitively intact bright clients....
I agree with lifestyle changes but sometimes meds are necessary. Helping clients be informed of the risks and the reasons for taking the meds (in writing). Going to doctors can be stressful. Have someone go with you to take good notes and make sure you get your questions (which should be written down) asked. Or record your visits. The stress and rush of the visit often makes it difficult for clients to remember, even younger, cognitively intact bright clients....
Regrettably, the situation described here can occur in nursing homes as well unless they require specialists called in to treat a resident to communicate with each other or with the resident's primary physician.
I speak from admittedly anecdotal experience.
I speak from admittedly anecdotal experience.
10
This article highlights a significant issue for "healthy" adults, who often add supplements to their regimine of prescribed medications. At least there is some choice involved. The medicating of people with dementia is a whole 'nether level of over-prescribing-- the layering on of medication after medication, to show the family that the doctor is doing something, to give a little hope where there really isn't any (yet, at least), without concern for combination effect, effectiveness nor cost. Medicare Part D is the ringleader in this crime, along with advertising of prescription drugs & fragmented medical care. A rational, single payer system would go a long way to solving this, but Big Pharma does not want a solution.
46
it is why it's so important for family to educate themselves, because sometimes someone has to put the brakes on and ask why exactly certain prescriptions are being provided (especially in nursing homes).
3
My son who is a pharmacologist points out that when you take one drug you are performing two experiments on yourself, the same two that were performed in drug trials. Each time you add a drug the number of experiments increases exponentially. At the point you are taking 10 drugs the experiment count is over 1000 so predicting how your body will react is next to impossible. Itt is also easy to pile up the drugs. I am close to 70, am very healthy and take an aspirin two supplements and two commonly prescribed drugs. It is important to be aware that adding another life saving or enhancing drug to the mix is. not without risk.
6
As A Nephrologist,I was trained to ask for OTC meds 35 years ago.I insist on patients bring ALL meds"BrownBag" or check ALL meds.Common problems include duplication of similar acting meds[vasodilators]Taking NSAID, diuretic and ACE/ARB and causing ChronicKidneyDisease.To be cynical GOOD FOR MY BUSINESS!!!
5
Don't those brown bag surveys eat up all the 15 mins allotted per visit?
2
Would you rather be safe or sorry ?
Additionally many OTC drugs have side effects that patients then take other meds to counter. For instance proton pump inhibitors reduce absorption of essential minerals and vitamins including calcium, magnesium, and B12 leading to symptoms like diarrhea, muscle cramps, anemia, and possibly depression.
6
Figuring out how many pills to take for each of my medications is my main mental activity, so that is one advantage of taking multiple medications. In addition, pharmacy dispense each and every one of them in an identical container with an identical white top. That makes the brain work much harder than with color coded caps. Variety is the spice of life, in pharmaceuticals as in everything else. Having one med you can inject, another you must inhale, also adds variety. But never, never, mix placebos.
2
As a 13 year expatriate in France, I have no medicare coverage since it is not valid outside the United States. Supplements are not as popular in France although homeopathic medicines are fairly popular.
Since France has the highest rated health care system in the world, all I needed to do after moving here was to develop a solid working relationship with my primary physician, including a periodic review of all medications and supplements.
Interactions between drugs can be dangerous or affect the quality of life. Prince's recent death at 57 may turn out to be an accidental overdose of a painkiller or a deadly combination between percocet and phenobarbital, taken for epileptic seizures.
My position with doctors and drugs is to be proactive in asking my physician for help, including problems with side effects. If my doctor is not responsive or helpful, then I will find a more engaged doctor!
Since France has the highest rated health care system in the world, all I needed to do after moving here was to develop a solid working relationship with my primary physician, including a periodic review of all medications and supplements.
Interactions between drugs can be dangerous or affect the quality of life. Prince's recent death at 57 may turn out to be an accidental overdose of a painkiller or a deadly combination between percocet and phenobarbital, taken for epileptic seizures.
My position with doctors and drugs is to be proactive in asking my physician for help, including problems with side effects. If my doctor is not responsive or helpful, then I will find a more engaged doctor!
6
Wouldn't it be nice if Big Pharma used a fraction of their lobbying expenses to build a website that would allow everyone to anonymously identify conflicts between all medicines and supplements.
Oh wait, they would just steal your data and use it to sell you something else you don't need.
Oh wait, they would just steal your data and use it to sell you something else you don't need.
25
Or to discriminate in a job application or life insurance, which is another reason I will never use any of the online monitoring devices.
4
iPhone has an Epocrates app that will give you a brief analysis of the interactions (if any exist) of the meds you are taking
Despite the benefit of comprehensive medication counseling to assist patients in managing their drug therapy and achieving better health outcomes, our current health care system does not value the time providers spend on these activities. Physicians and pharmacists do their best under these circumstances to meet the needs of their patients. A comprehensive medication review for a patient on multiple medications takes an average of 45 minutes, not including the follow-up required to eliminate duplicate medications, potential drug interactions, as well was sub-optimal therapy. And despite new electronic medical record systems, medication lists reflected in these systems may be different at every provider's office or different pharmacy a patient visits, since they often use different systems.
I recommend to all patients that they maintain an accurate list of all the medications and supplements they are taking that they can share at every medical appointment. And that they request periodic comprehensive review from their providers, including why they are taking the medication.
I recommend to all patients that they maintain an accurate list of all the medications and supplements they are taking that they can share at every medical appointment. And that they request periodic comprehensive review from their providers, including why they are taking the medication.
22
A medication review lasting 45 minutes may be the right thing to do, but most insurance plans allot far less, like 15 minutes for an office visit. I've had physicals that did not last much longer — and I have a fantastic PCP.
As for the dubious quality of the highly hyped electronic medical records systems, no kidding.
Doctors are forced to code and record myriad data, much of it relevant only to insurers, who are looking for ways to reduce costs not necessarily trying to provide better health care.
Kudos to you, K Rodondi, for being a conscientious doctor during an era when bean counters rule.
Lastly, having good health during old age does not begin, I believe, at age 50 or any age thereafter. A healthy old age depends on genetic good fortune, some luck, plus a healthy lifestyle — with an emphasis on moderation — beginning in childhood if not sooner.
As for the dubious quality of the highly hyped electronic medical records systems, no kidding.
Doctors are forced to code and record myriad data, much of it relevant only to insurers, who are looking for ways to reduce costs not necessarily trying to provide better health care.
Kudos to you, K Rodondi, for being a conscientious doctor during an era when bean counters rule.
Lastly, having good health during old age does not begin, I believe, at age 50 or any age thereafter. A healthy old age depends on genetic good fortune, some luck, plus a healthy lifestyle — with an emphasis on moderation — beginning in childhood if not sooner.
3
My primary care doctor recommends a plethora of specialists. Why so many specialists when only one or two are needed and a goodly number of supplements are used. Body no longer has the ability to heal and/or keep well. I tell you true that my feet and legs hurt beyond bearing. Never could tolerate NSAIDS but there's always acetaminophen several times a day. HELP! I propose the medical industry is behind all of this. You know, corporations so large that they go overseas to produce more and more. Isn't Big Pharma the largest of all?
4
Well, if your physician is in a physician organization (merged practices or hospital organizations), he/she is paid/rewarded in some way, to do so (recommend specialists).
I take 15 supplements daily (and no prescriptions.) I gave my doctor a list that she put in my file.
I do feel better from my supplements. Here is an example: I take calcium citrate 400 mg, and magnesium citrate 200 mg daily. Previously I would get cramps and I had premature atrial contractions (PAC's.) I rarely get them now.
To stay healthy we need to play an active role in what our body needs. Doctors learn to treat disease. It is our job to prevent disease that is preventable. Doctors are a resource, but we are responsible to be our own health manager.
I do feel better from my supplements. Here is an example: I take calcium citrate 400 mg, and magnesium citrate 200 mg daily. Previously I would get cramps and I had premature atrial contractions (PAC's.) I rarely get them now.
To stay healthy we need to play an active role in what our body needs. Doctors learn to treat disease. It is our job to prevent disease that is preventable. Doctors are a resource, but we are responsible to be our own health manager.
7
@Eric: A very good comment! Calcium is of course very important, but magnesium is often overlooked as a critically necessary mineral.
For those who have trouble taking magnesium orally (due to its effect on the intestines), try using a little PURE MAGNESIUM OIL on your skin. "Magnesium oil" isn't really "oil" at all - it is magnesium brine and feels slippery when you put it on your skin. Magnesium applied to the skin in this form is readily absorbed, dries quickly without being oily at all, has no smell, and won't leave a residue (unless you use too much, in which case your skin will feel briny - if that happens, just rinse the excess off).
If you get a muscle cramp or knot, a little Magnesium oil rubbed into the spot will often help release the cramp within a minute.
For those who have trouble taking magnesium orally (due to its effect on the intestines), try using a little PURE MAGNESIUM OIL on your skin. "Magnesium oil" isn't really "oil" at all - it is magnesium brine and feels slippery when you put it on your skin. Magnesium applied to the skin in this form is readily absorbed, dries quickly without being oily at all, has no smell, and won't leave a residue (unless you use too much, in which case your skin will feel briny - if that happens, just rinse the excess off).
If you get a muscle cramp or knot, a little Magnesium oil rubbed into the spot will often help release the cramp within a minute.
13
I used to take Ca supplements, but studies linking that habit to heart disease convinced me to stop. The problem with supplements over time is that though they may help one thing they can cause other, often more serious problems.
Ditto for over the counter meds. There was a report recently that over the counter antacid drugs increase the chances of developing dementia by 40% - some types of them also carry other health risks. NSAIDS (e.g., Aleve, ibuprofen) have been tied to heart failure...
Folks are often aware of the problems with prescription drugs; some avoid them. Yet, supplements and 'harmless' over the counter meds also carry significant risks.
Ditto for over the counter meds. There was a report recently that over the counter antacid drugs increase the chances of developing dementia by 40% - some types of them also carry other health risks. NSAIDS (e.g., Aleve, ibuprofen) have been tied to heart failure...
Folks are often aware of the problems with prescription drugs; some avoid them. Yet, supplements and 'harmless' over the counter meds also carry significant risks.
3
I am going on 67, take no medication whatsoever, apart from a calcium and Vitamin E supplement, which I can stop at any time. In my mind, massive use of supplements is also a problem. I had one American acquaintance who had a cosmetics bag loaded with supplements of which she swallowed a handful at every meal. Now those were supplements. Imagine them in combination with various kinds of prescription medication - there is the possibility of clashes.
I am, in a way, my own health manager. My doctor suggests something? I check out every detail, then accept or reject. I do weight and endurance training three times a week, walk everywhere, carry my shopping in a backpack, watch what I eat, but will happily go overboard on food every now and then, yet my weight is normal. My doctor approves, sees no problems and only wants me to come for my health checks once a year.
I am, in a way, my own health manager. My doctor suggests something? I check out every detail, then accept or reject. I do weight and endurance training three times a week, walk everywhere, carry my shopping in a backpack, watch what I eat, but will happily go overboard on food every now and then, yet my weight is normal. My doctor approves, sees no problems and only wants me to come for my health checks once a year.
11
Several years ago on an 'older folks' tour (everyone over 55) one of the participants said jokingly, "Everyone bring your bag of pills to breakfast tomorrow morning; whoever has the most wins." No one did, but it would have been interesting.
2
I am very old. I have many pain-related problems. About my "Polypharmacy": GO AWAY!!!! I need all the help I can get. Leave me alone. And my doctors. And my pharmacists. Unfortunately, I must declare great problems for YOUR physical future: LIFE WILL HURT! Like Hell! Now, go away and leave my pills alone. And wait for the pain.......IT IS COMING!
35
Yeah if I'm ever forced to be addicted to what is essentially heroin (I'm assuming you are on a bunch of opiates) by doctors, I don't think I would allow it. I used to be an oxycontin addict, and when I quit I met sooooo many seniors who were addicted to pain medicine until they died. They would be in a fog, not really living life, just waiting for the end to come. I'd rather live my life as healthy and addiction-free as I can, and if the pain ever becomes too much, I think I'd probably end it. Doctors want to think they can give us options to live forever, but in reality we cannot. Opiates are the worst medicine on planet earth. Try CBD, all natural and very effective for chronic pain while not being addictive and evil :-)
i bring a cv to each doctor which lists my prescription and otc pills, other doctors with addresses and phones, and all major incidents. we discuss all, and go from there. my excellent pharmacy always calls not only when a scrip is ready but if anything 'raises a flag' to them.
3
And, do not forget: that "FLAG" is just as dangerous if not more so than the original problem. Just you wait, Henry Higgins!
2
Linh,
But do you only shop @ one pharmacy ?
But do you only shop @ one pharmacy ?
It's hard keeping up with your prescriptions. I have tried those little plastic pill containers and an alarm clock, but nothing seems to work. Recently, I suggested to my wife that we hire a supermodel to deliver my pills to me. But she wasn't enthusiastic about the idea.
19
Yes! Been thru that! Finally ended up with each of us counting and directing and ensuring consumption of all those little pills we need. So far it is working.....I think....
3
Here's an easy way to never miss taking a pill. Give your dog a treat every time you take a pill. Pretty soon your dog will be reminding you it's time for his next treat (and time for your next pill). It really works!
1
I'm a senior who takes several medications for several conditions. I've been taking one combination of drugs for high cholesterol for 20 years without ill effects.
My pharmacy and Part D insurance company now run my medications through a database to flag possible adverse interactions. That may sound like a good thing, and in many cases it surely is, but in my case my insurance company's default position is that it won't pay my claim for a generic drug until my physician provides what the insurer considers acceptable proof that the medication has been properly prescribed.
The only ill effect I'm experiencing from the interaction of my medications is my insurer's high-handed denial of my claims, forcing me to choose between not taking a medication my physician and I consider necessary and effective and paying for the medication myself. And it never stops. First Drug A is flagged, then Drug B.
My insurer, of course, is not looking out for me. It's looking out for itself; looking for ways to deny claims and increase profits. It would be happy if I died tomorrow.
Crusades to save seniors from polypharmacy may help some seniors. But they also help insurers find excuses to deny claims and make the life of some seniors more unpleasant and potentially shorter.
My pharmacy and Part D insurance company now run my medications through a database to flag possible adverse interactions. That may sound like a good thing, and in many cases it surely is, but in my case my insurance company's default position is that it won't pay my claim for a generic drug until my physician provides what the insurer considers acceptable proof that the medication has been properly prescribed.
The only ill effect I'm experiencing from the interaction of my medications is my insurer's high-handed denial of my claims, forcing me to choose between not taking a medication my physician and I consider necessary and effective and paying for the medication myself. And it never stops. First Drug A is flagged, then Drug B.
My insurer, of course, is not looking out for me. It's looking out for itself; looking for ways to deny claims and increase profits. It would be happy if I died tomorrow.
Crusades to save seniors from polypharmacy may help some seniors. But they also help insurers find excuses to deny claims and make the life of some seniors more unpleasant and potentially shorter.
62
What Part D drug plan are you with? Did the plan reveal its restrictions on these drugs in its Annual Notice of Change that you should have received from the plan last fall, before the Medicare annual enrollment period? Or did you use the Medicare Plan Finder (on www.medicare.gov) to select a plan for 2016? That would also have revealed any restrictions the plan imposes on any of your drugs. Medicare counselors urge all Part D enrollees to review the ANOC if they are likely to remain in their current plan for the coming year, or to use the Plan Finder to help select a plan if they are thinking of switching. If the plan didn't reveal these restrictions in its ANOC or on the Plan Finder, it cannot impose them now.
1
less is more.
One of the benefits of Kaiser Permanente is having all your doctors under one roof.
They TALK to each other.
Single payer system.
My primary KNOWS what my cardiologist has prescribed and vice versa.
One of the benefits of Kaiser Permanente is having all your doctors under one roof.
They TALK to each other.
Single payer system.
My primary KNOWS what my cardiologist has prescribed and vice versa.
46
I'm also with Kaiser Permanente, Northern California. I appreciate the integrated approach and the emphasis on preventive care, such as a healthy lifestyle and vaccinations for things like shingles and pneumonia.
6
I have often thought it would be great to have a health plan that did a sort of "executive checkup"--all in one day in one location--incl mammogram, labs, maybe bone density, EKG, etc. Not this horrible specialist referral thing--where you could spend your entire existence wandering around and sitting in waiting rooms with all different approaches to every twinge and ache. But it is not to be--at least under my Medicare Adv Plan (BCBS).
2
The Star - AZ.
It is possible. It's called a concierge practice & it's priced accordingly.
It is possible. It's called a concierge practice & it's priced accordingly.
One of the drivers of polypharmacy is TV advertising of drugs where every ailment has a pill that "you can ask your doctor" about. The US is one of 2 countries that allows this fiasco. Oliver Wendell Holmes, when Dean of Harvard Medical School many years ago said "If the entire pharmacopoeia except for opiates was thrown into the ocean it would be better for mankind and awful for the fish." Of course we now have many life-saving drugs and we need to teach our medical students how to properly prescribe and provide continuing education to practicing physicians that is not sponsored by the drug industry. We also need to strengthen the FDA and not allow them to approve new drugs that are no better when compared to existing generics. Finally we need to elect a President and Congress that is not influenced by the lobbyists of the drug and insurance industries. Tommy Thompson, former Secretary of Health and Human Services in the GW Bush administration helped to push Medicare Part D (written in part by the CEO of Novartis) through Congress and refused to reveal the enormous cost to taxpayers and patients. Thompson now is a lobbyist for the drug industry. When will the electorate wake up to the corruption that is bankrupting our country?
120
Oliver Wendell Holmes, when Dean of Harvard Medical School many years ago said "If the entire pharmacopoeia except for opiates was thrown into the ocean it would be better for mankind and awful for the fish."
If only it stayed off the food chain, now its being "recycled" back to humans, Salmon off Seattle have all sorts of drugs from waste water flushed into the sea: http://www.seattletimes.com/seattle-news/environment/drugs-flooding-into... its probably true in other parts of the country and the world as well. I am sure there is strategy group within Pharma companies to figure out a way to either spin it in a positive way or make money from it...
The revolving door issue of politicians and key decision makers in Government bureaucracy who profit from their positions are well known and both political parties are complicit. Its a "retirement benefit." This will never change unless its made illegal and even then hard to stamp out.
If only it stayed off the food chain, now its being "recycled" back to humans, Salmon off Seattle have all sorts of drugs from waste water flushed into the sea: http://www.seattletimes.com/seattle-news/environment/drugs-flooding-into... its probably true in other parts of the country and the world as well. I am sure there is strategy group within Pharma companies to figure out a way to either spin it in a positive way or make money from it...
The revolving door issue of politicians and key decision makers in Government bureaucracy who profit from their positions are well known and both political parties are complicit. Its a "retirement benefit." This will never change unless its made illegal and even then hard to stamp out.
.... and in addition to Tommy Thompson's shenanigans we need to prevent the need for Senator's campaign coffers to be filled with $$$ from the pharmacy lobbyists. Otherwise the Pharma lobbyists will continue to actually write the legislation, including easing regulatory oversight of meds & devices and nothing will change. I think it starts with your vote for your Senators & Representatives (not the President). Have you grilled them before offering your vote ?
2
I am a 75 year old man who has been a pharmacist for over 50 years. When I first started in pharmacy almost no one had insurance for prescription drugs. As a consequence people only took medications that were absolutely necessary. Insurance came along and the use of medications skyrocketed, along with costs. Some of my current older customers are taking more than 20 different drugs. Once a person is over 80 years old, assuming no accidents, they are going to die either of a heart attack or cancer. Why take drugs to avoid a heart attack when dying of cancer is so horrific? By taking all these drugs we are not really living longer. we are just dying longer.
108
I felt the same way and was happy when a doctor in the hospital discontinued my 92 year old mother's blood thinning medications. Unfortunately, three weeks later she had a stroke and was bed-bound for the last year of her life. As much as I'm an advocate for natural treatments and take no prescription medication myself, my theory of preventing undue suffering for my mom didn't pan out as planned.
7
First of all, 50 years ago many of the most commonly prescribed drugs today didn't even exist. No statins, virtually no antihypertensives, few antidepressants, no diabetes drugs other than insulin, few cancer medications.
There are many people not only alive but living normal lives today because of these meds. I doubt many few of us would want to go back to when they didn't exist
As to that dying of a heart attack, I wouldn't mind dying of one just before getting terminal cancer. However, I don't know how one successfully times this nor how one can be assured that one doesn't survive that heart attack and suffers brain damage.
There are many people not only alive but living normal lives today because of these meds. I doubt many few of us would want to go back to when they didn't exist
As to that dying of a heart attack, I wouldn't mind dying of one just before getting terminal cancer. However, I don't know how one successfully times this nor how one can be assured that one doesn't survive that heart attack and suffers brain damage.
Every time I go to the doctor, along with vital signs, staff takes a list of perscribed medications, OTC meds and supplements. All my perscriptions go through my Primary Care doctor. I have occasionaly been advised to stop something, or advised that something really didn't do any good.
When I want to try a new supplement or OTC drug, I ask my pharmacist to check it against my prescriptions. In addition my HMO pays for an annual med check with the a pharmacist. They do that by phone and they are very thorough.
So...I feel I am pretty safe. One pharmacy and one doctor is really a good idea. You just have to stay out of the clutches of specialists.
When I want to try a new supplement or OTC drug, I ask my pharmacist to check it against my prescriptions. In addition my HMO pays for an annual med check with the a pharmacist. They do that by phone and they are very thorough.
So...I feel I am pretty safe. One pharmacy and one doctor is really a good idea. You just have to stay out of the clutches of specialists.
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I am 75 and a resident of the Garden State where every physician has access to the database of all prescriptions, but not to OTC drugs and supplements. I see as often as requested an internist, gastroenterologist, hematologist, nephrologist, ophthalmologist and a cardiologist.
I take as prescribed the following: Lisinopril, Nadolol, Allopurinol, Omeprazole, Pravastatin, Aspirin, Melatonin, Folic Acid, Align, Niacin ER, Vitamin D, Multivitamin and Flaxseed Oil.
The first question during every visit is: What medications are you taking? And my response is to provide a copy of the list of medications, including dosage, times, etc.
It is noteworthy that there is a conflict between the advice given by the kidney specialist and both the primary care provider and interventional cardiologist concerning the use of diuretics to reduce swelling around the ankles, a serious problem brought on by excessive dietary salt. Quite simply, reduce the amount of salt to the level in the DASH diet.
I take as prescribed the following: Lisinopril, Nadolol, Allopurinol, Omeprazole, Pravastatin, Aspirin, Melatonin, Folic Acid, Align, Niacin ER, Vitamin D, Multivitamin and Flaxseed Oil.
The first question during every visit is: What medications are you taking? And my response is to provide a copy of the list of medications, including dosage, times, etc.
It is noteworthy that there is a conflict between the advice given by the kidney specialist and both the primary care provider and interventional cardiologist concerning the use of diuretics to reduce swelling around the ankles, a serious problem brought on by excessive dietary salt. Quite simply, reduce the amount of salt to the level in the DASH diet.
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FYI, you can probably drop the Niacin ER, but talk to your cardiologist or primary about that. Our thinking about the benefits (or lack of, as we know now) of niacin has changed dramatically in the last several years. http://www.webmd.com/heart-disease/news/20140716/niacin-doesnt-reduce-he...
Um, no, Dr. Gumbs. Eventually with chronic kidney disease, particularly with marked proteinuria, no amount of salt restriction prevents edema. And presumably you developed edema on your typical daily diet?
As a nephrologist, I am often in conflict with cardiologists, many of whom suffer from Bo Jackson syndrome (Bo knows Cards, Bo knows Renal.....). And interventional cardiologists do just that - they intervene.
Interesting med list, which illustrates many of the issues in the article. I would assume that your multivitamin tab - which often contain magnesium, a no-no in kidney disease - has enough folic acid to obviate that extra folic acid pill. And the Niacin ER is worsening your hyperuricemia; it is a very potent anti-uricosuric. If your uric acid is still > 6.0 mg/dL most Rheumatologists would want you to be on a higher dose of allopurinol. But then the - out-of-date - guidelines on restricting allopurinol dose in kidney disease would tend to limit the dose of allopurinol prescribed. And alas, lead to less than ideal gout management.
As a nephrologist, I am often in conflict with cardiologists, many of whom suffer from Bo Jackson syndrome (Bo knows Cards, Bo knows Renal.....). And interventional cardiologists do just that - they intervene.
Interesting med list, which illustrates many of the issues in the article. I would assume that your multivitamin tab - which often contain magnesium, a no-no in kidney disease - has enough folic acid to obviate that extra folic acid pill. And the Niacin ER is worsening your hyperuricemia; it is a very potent anti-uricosuric. If your uric acid is still > 6.0 mg/dL most Rheumatologists would want you to be on a higher dose of allopurinol. But then the - out-of-date - guidelines on restricting allopurinol dose in kidney disease would tend to limit the dose of allopurinol prescribed. And alas, lead to less than ideal gout management.
1
I do "brown bag reviews" with my patients. They are time-consuming, but important. I think the fact that they are time-consuming contributes to their relative disuse; it's hard to fit everything into a 15-minute office visit, and insurance does not reimburse for this practice. So when I do it, I inevitably fall behind in my schedule.
Also just wanted to note that plavix (clopidogrel) + aspirin is commonly prescribed for 6 months to a year after a coronary stent is placed. The problem arises when the patient continues to take them after they are medically-indicated.
Also just wanted to note that plavix (clopidogrel) + aspirin is commonly prescribed for 6 months to a year after a coronary stent is placed. The problem arises when the patient continues to take them after they are medically-indicated.
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Another part of the problem is that stents are invasive and have not been shown to be effective.
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Yes, we've revised our wording to reflect that while this combination can be beneficial under certain circumstances, long-term use presents problems. Thanks for pointing out the distinction, JenD.
3
I was taking simvastatin for cholesterol. When I moved and changed doctors I told him I was taking the medication. He shook his head agreeing and never questioned the medication. "Just stay on it," he said. As I had also changed lifestyles (eating much more health) I suggested that we might drop the medication and see what my baseline is now (the medication was prescribed ten years ago). He said, "No, let's just keep it up." Now I don't get it. As important as it is to control certain physiological elements, it's just as important, at least to me, that they be monitored skeptically. Here was my new doctor simply leaning on an old diagnosis (that, without my records handy, he has no background to consult on to justify his diagnosis). So, I just stopped the medication myself and, when I return in six months for another checkup we'll get a baseline again. It just seems to me doctors move in only one direction, more intervention, more drugs. Not good medicine.
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Very easy reason for your doctor's behavior. Let's say you drop the statin and have a heart attack a few months later. Some enterprising lawyer may decide to make a buck off of a malpractice suit, claiming that you had a heart attack because he told you to drop the statin. Better to manage the medical legal risk than take you off a drug that is doing no harm.
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I hate that you are right, QED.
3
If you shopped around, you could get a cholesterol test on your own and look up what the results mean. That way, you know what's going on.
6
For patients older than age 65, all drugs without a 2 year number needed to treat of > 1.0% should not be taken by anyone ever.
That means if you took the drug everyday religiously for 2 years, there is a 99% chance it would not benefit you and only a 1 in a hundred chance it would!
That would eliminate all the vitamins, fish oils, over the counter pseudoscientific nonsense and about 25% of all prescription medicines too. Problem solved and billions saved.
That means if you took the drug everyday religiously for 2 years, there is a 99% chance it would not benefit you and only a 1 in a hundred chance it would!
That would eliminate all the vitamins, fish oils, over the counter pseudoscientific nonsense and about 25% of all prescription medicines too. Problem solved and billions saved.
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A "bigger part of the problem" is neither the medication nor the physician: it is the CDC. When the CDC decides to recommend something, watch out! It immediately becomes "unlawful", somehow, and doctors will not go near it.......
@Andrew: So you're in favor of vitamin deficiencies in the elderly??
As we age, our stomach acid is less powerful and we absorb less of the nutrients we ingest, so even someone eating a very good diet can end up with nutritional deficiencies.
A Vitamin B12 deficiency, if let go long enough, can land you in a nursing home with irreversible dementia. So think hard before you throw the good out with the bad.
PS: It took me a YEAR of deliberately taking Vitamin D3 supplements (with my doctor's approval) to get my blood level of D3 to the MINIMUM normal level. You can bet I'm not discontinuing D3 anytime soon.
As we age, our stomach acid is less powerful and we absorb less of the nutrients we ingest, so even someone eating a very good diet can end up with nutritional deficiencies.
A Vitamin B12 deficiency, if let go long enough, can land you in a nursing home with irreversible dementia. So think hard before you throw the good out with the bad.
PS: It took me a YEAR of deliberately taking Vitamin D3 supplements (with my doctor's approval) to get my blood level of D3 to the MINIMUM normal level. You can bet I'm not discontinuing D3 anytime soon.
20
Don't forget to take MK7 (vitamin K2) and magnesium to assure the vitamin D does not force calcium into your arteries. This is really important and your doctor should be telling you this, and not someone you don't know form a whole in the wall. But conventional doctors do not study this.
2
My mother is 86. She is taking a statin. Why? She was told that once on it, she has to stay on it the rest of her life. She is taking a blood thinner for a-fib. Sleeping pills to get to sleep (for decades now). Another pill for incontinence. All told, she is taking eight different meds each day. The only one that seems to be medically necessary is the blood thinner and I can understand the medication for the incontinence as a quality of life issue.
Every time we go to the doctor or the hospital, I carry a list of her meds. Not one medical professional has ever reviewed that list, much less suggested that one or more could be dropped.
Not me. I'm 60 and fighting every day to eat right and exercise. I take no meds other than an 81 mg aspirin (due to family history of colon cancer) and magnesium due to past incidents of ventricular tachycardia. I don't want to live XX years. I want to live XX years healthy. And when I can't do the things I love to do, then I'm outta here.
Every time we go to the doctor or the hospital, I carry a list of her meds. Not one medical professional has ever reviewed that list, much less suggested that one or more could be dropped.
Not me. I'm 60 and fighting every day to eat right and exercise. I take no meds other than an 81 mg aspirin (due to family history of colon cancer) and magnesium due to past incidents of ventricular tachycardia. I don't want to live XX years. I want to live XX years healthy. And when I can't do the things I love to do, then I'm outta here.
110
My 90 year old mother was told to take a statin several years ago. She refused. Same with a colonoscopy. if it ain't broke...
1
For those who don't want to put everything in a bag and present it at the doctor's, how about photographing all the containers with the camera on their phone. Assuming they, or the person taking them to the doctor, have a phone, this could be easier.
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When all of the medications are brought in to the doctor or pharmacist, it's easier to group medications by diagnosis, identify duplicates, and discard unneeded medication. All of these interventions are especially helpful in-person for people with memory problems.
1