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SIDE EFFECTS OF COMMON DRUGS LEAD TO MORE DRUGS · Your Daily Dose

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  Speaker 1: If you've ever wondered why naturopathic approaches have become so popular,
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  Speaker 1: it's because of the failures, honestly, of traditional allopathic medicine.
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  Speaker 1: So a new study comes out in the Journal of
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  Speaker 1: Drugs and Treatment, a study of nearly 2.3 million older adults.
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  Speaker 1: And it's intriguing to see the mistakes that allopathic medicine
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  Speaker 1: is making, which is leading to over-prescribing of medication. So
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  Speaker 1: we're going to take a look at this study that
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  Speaker 1: just came out. Stay tuned.
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  Speaker 2: Hi, and welcome to Health Talk with Dr.
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  Speaker 3: Len, your daily dose.
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  Speaker 2: The information you hear on this show is informational. It's
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  Speaker 2: not meant to diagnose or treat any disease.
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  Speaker 1: Any kind of complete health conditions must be checked out
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  Speaker 1: and discussed with your primary care physician.
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  Speaker 2: Get ready for the good news of the day. God
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  Speaker 2: bless you folks. And here is Dr. Len.
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  Speaker 1: Our daily devotional today comes from the book of Jeremiah
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  Speaker 1: chapter 31. You've been on a long uphill journey, and
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  Speaker 1: your energy is almost spent. Though you have faltered at times,
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  Speaker 1: you've not let go of my hand. I am pleased
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  Speaker 1: with your desire to stay close to me. There is
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  Speaker 1: one thing, however, that displeases me, your tendency to complain.
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  Speaker 1: You may talk to me as much as you like
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  Speaker 1: about the difficulties on the path we're following. I understand
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  Speaker 1: better than anyone else the stresses and strains that have
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  Speaker 1: affected you.
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  Speaker 3: You can ventilate safely to me.
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  Speaker 1: Because talking with me tempers your thoughts and helps you
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  Speaker 1: to see things from my perspective. Complaining to others is
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  Speaker 1: another matter altogether. It opens up the door to deadly
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  Speaker 1: sin such as self-pity and rage. Whenever you're tempted to grumble,
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  Speaker 1: come to me and talk it out. As you open
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  Speaker 1: up to me, I will put my thoughts in your
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  Speaker 1: mind and my song in your heart. It's a good
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  Speaker 1: lesson for all of us. 727-916-4215 An 87-year-old man went
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  Speaker 1: to the hospital with COVID-19. His memory was a little
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  Speaker 1: shaky on a good day. Doctors gave him steroids to
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  Speaker 1: treat the illness. Remember all that? While in the hospital,
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  Speaker 1: he grew confused. At night, he tried to climb out
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  Speaker 1: of bed. He fought the staff. A sitter had to
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  Speaker 1: be placed at his bedside.
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  Speaker 3: Dr.
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  Speaker 1: George Hennewee, a geriatrician, who directs the Center for Successful
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  Speaker 1: Aging at MedStar Good Samaritan Hospital in Baltimore, was called in.
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  Speaker 1: The man had already been given a dose of medication
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  Speaker 1: to control the agitation. His team looked at the history
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  Speaker 1: of the stay. They lowered the steroid dose and moved
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  Speaker 1: it to morning. Gradually, he returned to baseline and were
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  Speaker 1: able to discontinue the sitter and get him up walking again.
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  Speaker 1: The choice between treating the new symptom and looking for
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  Speaker 1: the last prescription is familiar fork in geriatric care. A
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  Speaker 1: study of nearly 2.3 million older adults published Thursday in
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  Speaker 1: the British Medical Journal quantified how these patterns appear. Researchers
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  Speaker 1: started with 65 suspected drug pairings. They found 24 in
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  Speaker 1: which one medicine was often followed by another used to
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  Speaker 1: treat a known side effect of the first. The strongest
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  Speaker 1: link mirrored Hanawi's patient, a steroid and an antipsychotic. The
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  Speaker 1: records show which drug came first, why not the second
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  Speaker 1: one was prescribed. Researchers could not say. Many of these
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  Speaker 1: pairings were true prescribing cascades. However, they appeared often enough
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  Speaker 1: in order to deserve a closer look. A prescribing cascade
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  Speaker 1: happens when a side effect of one medication is mistaken
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  Speaker 1: for a new health.
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  Speaker 3: Problem and treated with another drug. Sound familiar?
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  Speaker 1: And Alway drills the same role into his residents. When
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  Speaker 1: a new symptom follows a new prescription, look at the
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  Speaker 1: medicine first. These sequences of events are common but often
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  Speaker 1: missed in clinical practice, said Paula Roshon, the study's lead author.
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  Speaker 1: Ontario's public health program keeps a record of prescriptions dispensed
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  Speaker 1: to older residents. Researchers use these records to study 2.3
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  Speaker 1: million community-dwelling adults 66 and older. They started with 65
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  Speaker 1: possible prescribing cascades identified by the International Panel of Experts.
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  Speaker 1: Then they asked three questions of each pairing. Is the
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  Speaker 1: first drug widely used? Does the second drug follow often?
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  Speaker 1: And does it follow more often than expected? 24 combinations
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  Speaker 1: passed all three tests, and many of them were in
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  Speaker 1: American medicine cabinets. Iron pills topped the list. Nearly 12%
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  Speaker 1: of older adults who started iron received a prescription laxative
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  Speaker 1: within a year.
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  Speaker 3: 1 in 8. Statins came next. Hmm.
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  Speaker 1: 10.9% of new users, about 1 in 9, were given
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  Speaker 1: a prescription pain reliever. Statins were also among the most
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  Speaker 1: widely used drugs in the study, dispensed to 55% of
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  Speaker 1: older adults. And I have stressed over and over again,
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  Speaker 1: the value of use in statins in those over the
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  Speaker 1: age of 65 has not bore out any extension in life.
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  Speaker 1: Third was a pairing that will matter to families caring
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  Speaker 1: for someone with dementia. But 1 in 10 people who
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  Speaker 1: had started a cholinesterase inhibitor, a class of drugs that
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  Speaker 1: includes donazepril, were prescribed a sleep aid within a year
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  Speaker 1: That matters because some sleep medications can themselves impair cognition.
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  Speaker 1: The sequence caught the attention of Judith Belzer, a clinical
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  Speaker 1: pharmacist and professor at St.
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  Speaker 3: John's University.
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  Speaker 1: Dynasapril can interfere with sleep in some patients, she said.
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  Speaker 1: Moving the dose to morning may help before adding another medicine.
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  Speaker 1: These patterns sound familiar to anyone who watched a patient's
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  Speaker 1: pill organizer fill up. About 7.5% of all those who
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  Speaker 1: started a calcium channel blocker, such as amlodipine, common blood
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  Speaker 1: pressure drug that could swell your ankles. We're prescribed a
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  Speaker 1: water pill within a year. Nearly 1 in 18 new steroid.
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  Speaker 3: Users were given a sleep aid.
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  Speaker 1: 1 in 15 people who started an anti-inflammatory such as
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  Speaker 1: naproxen got the stomach protector, and 3% got a new
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  Speaker 1: blood pressure medication because of the anti-inflammatory.
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  Speaker 3: We've been seeing this for years.
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  Speaker 1: What surprised me most was not the specific cascades themselves,
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  Speaker 1: but the scale of the problem. The study moved prescribing
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  Speaker 1: Cascades from a conceptual issue to a measurable one. Study
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  Speaker 1: also leaves part of the medicine cabinet invisible. It did
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  Speaker 1: not count over-the-counter drugs, which researchers said may mean Cascades
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  Speaker 1: are uncounted. In both Canada and the United States, common
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  Speaker 1: pain relievers, acid reducers, and iron supplements can be bought
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  Speaker 1: without a prescription. Most people are not being prescribed iron.
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  Speaker 1: The doctor says go to the pharmacy, pick up a
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  Speaker 1: bottle of iron. Those prescriptions leave no Those purchases leave
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  Speaker 1: no prescription trail.
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  Speaker 3: The same is true of pain medications.
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  Speaker 1: Someone who develops aching muscles after starting a statin may
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  Speaker 1: simply buy ibuprofen.
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  Speaker 3: The study will never see it.
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  Speaker 1: As much larger the anti-inflammatory cascade might be, over-the-counter use
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  Speaker 1: is counted. In older adults, side effects often look like aging. Dizziness, swelling,
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  Speaker 1: urinary symptoms, fatigue, insomnia, and constipation are all common complaints.
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  Speaker 1: The statin finding drew more skepticism. Nearly 11% of people
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  Speaker 1: who started a statin later received a prescription pain reliever.
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  Speaker 1: I think that one surprised me most, was that the
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  Speaker 1: statin to pain reliever cascade.
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  Speaker 3: Dr.
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  Speaker 1: Anne-Marie Navarre, a cardiologist at UT Southern Western Medical Center,
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  Speaker 1: cautioned against reading that number as evidence that statins are
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  Speaker 1: causing muscle pain. It's almost hilarious how doctors downplay these things.
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  Speaker 1: Musculoskeletal complaints are common in older adults, she said. Nearly
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  Speaker 1: as many people have studied and started pain reliever before
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  Speaker 1: the statin at all. Don't blame the statin, she said.
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  Speaker 1: I think it's a stretch to consider those things to
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  Speaker 1: be causal. I think she's full of it.
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  Speaker 2: Dr.
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  Speaker 1: Aaron Troy, a clinician and fellow in cardiology and geriatrics
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  Speaker 1: at Johns Hopkins, said that patients who develop a cough
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  Speaker 1: after starting lisinopril should ask whether the drug could be
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  Speaker 1: responsible and whether an alternative such as lisartan.
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  Speaker 3: Would be a better fit.
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  Speaker 1: Some symptoms are simply hard to trace, said Nancy Schoenborn,
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  Speaker 1: a geriatrician at Johns Hopkins. Depression may be another blind spot,
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  Speaker 1: but 1 in 16 new opioid users and 1 in
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  Speaker 1: 19 new beta blocker users were prescribed antidepressants within a year.
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  Speaker 1: Clinicians readily think of fatigue and dizziness with those drugs,
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  Speaker 1: but depression is less likely thought about as a side effect.
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  Speaker 1: The calendar hides the trail, too. The researchers noted some
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  Speaker 1: cascades emerge quickly, while others take months to appear.
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  Speaker 3: Time is probably the biggest barrier, they said.
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  Speaker 1: Older adults may have long medication lists and several specialists
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  Speaker 1: prescribing at different times. Reconstructing when a symptom began and
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  Speaker 1: what changed just before it can be difficult is in
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  Speaker 1: short office visits. The records can be scattered too. In
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  Speaker 1: the United States, one patient may fill prescriptions at a
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  Speaker 1: neighborhood pharmacy through mail order and through the Department of
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  Speaker 1: Veterans Affairs. It would be so hard to investigate if
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  Speaker 1: the information was in so many places. Even Ontario's records,
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  Speaker 1: he added, did not contain all the clinical details needed
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  Speaker 1: to determine whether a possible cascade was really one. Prescription
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  Speaker 1: records cannot show why a second drug was added. This
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  Speaker 1: study identified patterns and associations only Bells are pointed to iron.
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  Speaker 1: Constipation is expected.
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  Speaker 3: Not necessarily.
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  Speaker 1: If you get the right form of iron, like Easy
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  Speaker 1: Iron by NF, Nutritional Frontiers, it doesn't cause constipation.
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  Speaker 3: Other times, the better move is to revisit the first drug.
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  Speaker 1: If you have low opinions causing some swollen ankles, avoid
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  Speaker 1: it rather than adding a diuretic.
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  Speaker 3: I'd rather see if we can get rid of the swelling.
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  Speaker 1: By making a switch than adding another medication. The study's
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  Speaker 1: authors want prescribing software to flag possible cascades and pharmacists
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  Speaker 1: to review them. I think we have prescribing cascades built
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  Speaker 1: into some of the prescribing software at this point. More
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  Speaker 1: alerts can create another problem. There are too many alerts,
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  Speaker 1: then you get alert fatigue. Do you see the problem
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  Speaker 1: with allopathy? They're trying to downplay this to the nth degree.
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  Speaker 1: Don't question my prescribing habits, says Dr. A., I know
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  Speaker 1: better than you, says Dr. A. Don't make me change
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  Speaker 1: what I've been doing for decades, says Dr. A. And
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  Speaker 1: when a pharmacist gets involved, they start downplaying the pharmacist.
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  Speaker 1: That's the way allopathy works. So what can a patient do?
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  Speaker 1: When a symptom appears, start by asking what changed.
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  Speaker 3: And then.
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  Speaker 1: Do some research on your own or call your pharmacist
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  Speaker 1: and find out what's going on. The clinicians are your partners.
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  Speaker 1: It's a good way to help rather than burden most doctors.
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  Speaker 1: The record, he said, let the doctor adjust or stop
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  Speaker 1: the medication rather than adding another one. And oftentimes, the
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  Speaker 1: pharmacist will have to be at the front line of that.
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  Speaker 1: Take a look at your own list of medications. Were
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  Speaker 1: any of those added because of the side effect of
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  Speaker 1: the first? If it was, talk to a pharmacist. Or
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  Speaker 1: give me a call, 727-916-9000. That's our word.
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  Speaker 3: For the day. God bless you folks. Have a great week.