The Medicine Men:

Seniors Could Be Medicated to Death

February 1, 2001

Michael Arnold Glueck, MD & Robert J Cihak, MD

"Hazardous to seniors’ health." That could be the warning if unlimited prescription drug coverage under Medicare is passed into law. It's bad enough getting older without being medicated to death. But if seniors and doctors give in to the siren song of unlimited government-mandated "free drugs," the safety of all seniors could be seriously compromised.

President Bush has put forth a moderate proposal to cover prescriptions for the poorest seniors to give Congress time to consider ways to revamp Medicare to cover prescriptions for all seniors. But the ultimate result of other’s proposals for unlimited prescription drug coverage could be a big negative for seniors.

Many patients, particularly seniors or semi-seniors, take a wide variety of medicine for heart disease, hypertension, elevated cholesterol, diabetes, obesity, arthritis, chronic lung disease, etc. Many also use non-prescription vitamin and dietary supplements.

All medicines, even the best, have side effects, and some are pretty nasty! The good or beneficial effects of medication are the ones that treat disease or symptoms. The side effects can make you sick or kill you. For the patient there is always a price to pay in the delicate balancing act of benefits versus risks.

Sometimes under the rush to care no one physician, pharmacist or even the patient knows all the medications being ingested, injected, applied by patch, liquid, ointment or creme. And if Medicare is extended to cover all presciptions, the complications could be There's the rub!

A survey of 1,000 adults was conducted last fall for the American Society of Health System Pharmacists, which represents pharmacists who practice in hospitals and other health care institutions. As expected, more people tended to take more prescriptions as they grew older. Seventy-nine percent of respondents over age 65 reported taking at least one prescription drug each day, vs. 28 percent for those 44 or younger. The survey also found that about 8 percent of people entering a hospital don't report to doctors or nurses what medications they're taking.

Drugs, foods, emotions, exercise and just about everything else interact both positively and negatively with the body's natural defense mechanisms. Each of these elements may make a medicine less or more effective - which can lead to medical problems from not enough or too much drug activity. For example, "antacids can decrease the effectiveness of antibiotics." [Source below: Fries p.100]. For example a person on 2 medications will likely have fewer interactions than a patient on ten medications who will have the potential for millions (factorial 10) of drug interactions. Needless to say, no physician can completely understand all the interactions possible when multiple drugs are used.

Diseases interact as well; for example, high blood pressure can cause kidney failure. And kidney failure can increase high blood pressure.

With seniors averaging more than a dozen prescriptions every year, innumerable possible complications and interactions are possible. No wonder grandma or grandpa might seem a little sleepy for weeks or months on end.

Indeed, Dr. James Fries estimates that "10% to 20% of hospitalizations for seniors are the result of drug side effects." . By applying the timely tincture of simple sense there are ways to reduce the risks.

Avoiding medication problems is better than managing them later even though most people have problems sooner or later. For an excellent overview and more detailed guidance, we suggest "Living Well" by James F. Fries, MD. For example, "Seniors eliminate drugs from their body slowly and usually need only relatively low does."

Here are some easy recommendations:

• Be patient with your symptoms and your symptoms may become patient with you.

  "Instant relief" can lead to "instant complications"! Sometimes it's better to endure the mild symptoms (such as mild cough, fever, runny nose or pain) than to try to feel better instantly. Give your normal bodily defense mechanisms a chance to work!

• Avoid sleeping pills, pain pills and nerve pills IF possible. They have a lot of side effects and usually don't cure the problem.

• Changing lifestyle is better than medication. For example, you may love pickles - which are loaded with salt - but if your body retains fluids, your life will be much less complicated if you cut down on pickles instead of taking a diuretic (water pill).

• Minimize the variety and quantity of optional, non-prescription drugs you take.

• Keep your doctor advised of all medications. Make a list of ALL medications, vitamins and supplements and check it twice. The list should include name, use, dosage, and how often you really take every pill, tablet, etc.

• Update your list every time you see a new doctor; change, add, or subtract medications, and alter dosages.

• Make sure your physician sees your list with each visit. Have it ready to save valuable time particularly during the for-profit managed care eight minute office visit.

• Your physician should likewise keep a copy of your medication list.

• Try to minimize the number of pharmacies used and keep your pharmacist up to date.

• Most pharmacists have a computer program which can check for drug interactions. Ask him or her to check every time you get a new prescription. However, if you use several pharmacies the problem is that these computers presently do not connect to other chains or even within their own network.

• Avoid overuse of alcohol. One dose (drink) per day may be healthful to most people, Although Irish playwright Brendan Behan once quipped, "There's no such thing as a large whiskey", his liver did give out before he was 40.

The good news is that Americans are living longer and better than ever before. By following these common sense rules the patient, family, physician, and pharmacist will benefit. Although most of us will ultimately require some type of medication, there is no reason to be medicated to sleep or death! Prevention is healthier than cure.

[Source note: "Living Well" by James F. Fries, MD, Addison-Wesley Publishing Co., Reading MA, Menlo Park CA. 1994]

Michael Arnold Glueck, MD, Newport Beach, Calif., has written extensively on medical and legal reform issues.

AAPS has a simple, cost-effective proposal to provide prescription drug coverage for seniors under Medicare through vouchers.

For more information, please see:

• AAPS Proposal for Medicare Reform