Cold Beers

Health Sciences Institute e-Alert

August 18, 2004

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Dear Reader,

There's no other way to put it: Far too many doctors are letting seniors down.

A new study from Duke University reveals disturbing evidence that more than 20 percent of all seniors who are prescribed drugs are receiving medications that are known to be harmful to older patients.

This lapse in "care-giving" is nothing less than shameful. But it serves as a stark warning: No one should meekly accept what a doctor prescribes. Ask questions. Research. Take control of your health care.

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Slipping through the cracks
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In the early 90s, Mark Beers, M.D., and several other specialists in geriatric drug therapy, developed a list of medications that were inappropriate for nursing home residents. The list now known as the Beers List was amended in 1997, and updated in 2003, and has become a well known tool for guiding doctors away from prescribing medications that may be harmful when taken by older patients.

In an interview with HealthDayNews, Dr. Kevin Schulman, a professor of internal medicine at Duke University and one of the authors of the study, said that even though someone over the age of 65 may be in good health, their kidneys don't function as well as they did when they were younger. This is one of the primary reasons that some medications can be harmful. Antidepressants and muscle relaxants can put particular stress on the kidneys.

The Duke team examined the outpatient prescription claims for more than 765,000 people aged 65 or older who had more than one prescription filled during 1999. Using the Beers List, the researchers produced this data:


* More than 20 percent of patients over the age of 65 may be taking inappropriate prescription drugs
* More than 15 percent of these patients received prescriptions for two or more of the drugs on the Beers List
* Four percent of the patients were prescribed three or more drugs on the list
* Psychotropic drugs (such as antidepressants) on the Beers List were prescribed the most, totaling more than 40 percent of the prescriptions
* Muscle relaxants on the Beers List were the second most commonly prescribed

Obviously, there are quite a few doctors out there who are asleep at the switch. And as a result, their patients may be suffering.

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Adding up the danger
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Kidney stress caused by drugs on the Beers List is by no means the only health problem older people face when filling prescriptions.

In the September 1999 HSI Members Alert, we told you how drugs can interfere with the absorption of nutrients. For instance, acid blockers (such as Prilosec and Nexium) have been shown to significantly decrease absorption of vitamin B-12; one of the primary vitamins needed to prevent anemia.

Other medications that are known to play a role in nutrient depletion are among the most frequently prescribed drugs on the market. Antibiotics, anti-depressants, anti-inflammatories, blood pressure medications, cholesterol-lowering drugs, estrogen, and tranquilizers can all strip valuable vitamins and minerals from the body. When two or more of these drugs are combined - especially in an older patient - the risk of developing anemia rises.

And that's when things can get really complicated, because anemia dramatically increases mortality risk for patients with chronic health problems such as heart disease and cancer.

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How much can you take?
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The harm that a single drug may do by stressing the kidneys and depleting nutrients is small compared to the harm that can occur when several drugs are taken at the same time.

In the e-Alert "Iron in the Fire" (6/3/03), I told you about a study conducted by Medco Health Solutions, Inc. (a company that manages drug benefit plans). Researchers concluded with this shocking statistic: the average senior receives 25 prescriptions annually - a 100 percent jump from just five years ago!

As the over-medication of seniors grows at an alarming rate, we see two serious problems becoming even greater health threats: 1) the wider variety of drug intake creates conflicting side effects (and as we've seen before, many doctors treat drug side effects with additional drugs), and 2) these potent drug mixes rob patients of the very nutrients they need most when fighting an illness.

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New coin
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A few days ago I came across a word that was new to me: Polypharmacy. This is the practice of prescribing too many medications.

Along with polypharmacy I would coin this word: Negligentpharmacy; the practice of prescribing drugs that are known to be harmful to certain patients.

Unfortunately, many older people are victims of both polypharmacy and negligentpharmacy because too many doctors are not well trained or conscientious enough to know the harm that some drugs may cause. That's why young and old patients alike have to be diligent whenever their doctor writes a prescription.

Ask questions. Research. Take control of your health care.

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...and another thing

For some of us, antidepressant drugs are only as far away as our kitchen faucet.

You may have heard about the recent report from the UK that traces of Prozac have been found in the drinking water there. Needless to say, British environmentalists are nearly apoplectic, as well they should be.

Apparently Prozac finds its way into the water system by way of treated sewage water. Or you might call it not-treated-enough sewage water. But whatever you call it, there's no getting around the fact that Prozac in tap water has already been ingested and digested by someone else.

Not exactly what you would call "jolly good!"

According to the BBC, a Drinking Water Inspectorate spokesman said that the Prozac was "most likely highly diluted." Wow... "Most likely." THAT'S reassuring!

One of the disturbing aspects of this very disturbing situation, is the fact that Prozac is one of the drugs that appears on the Beers List. So whether they want to or not, elderly people in Britain may be picking up a little Prozac in their afternoon tea.

Meanwhile, back here in the U.S., we've had Prozac in our waterways for months already.

In the e-Alert "Air Freshener" (11/5/03), I told you about Bryan Brooks, a Baylor University toxicologist, who discovered traces of Prozac's active ingredient (fluoxetine) in the tissue of blue gill fish in a lake in Dallas, Texas. Brooks speculated that the fluoxetine made its way from the urine of Prozac users, through a water treatment plant, and into the lake.

So there's your proof from England to east Texas what goes around comes around.

Over the past few years, worldwide sales of Prozac have totaled well over $2 billion per year. I think I'll have the distilled water, please.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

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Sources:

"Inappropriate Prescribing for Elderly Americans in a Large Outpatient Population" Archives of Internal Medicine, Vol. 164, No. 15, August 2004, arcinte.ama-assn.org
"Many Older Patients on Risky Drugs" Steven Reinberg, HealthDayNews, 8/9/04, story.news.yahoo.com
"Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Results of a US Consensus Panel of Experts" Archives of Internal Medicine, Vol. 163, No. 22, December 2003, ncbi.nlm.nih.gov
"New Data Uncovers Medication Matrix: Multiple Physicians, Pharmacies and Drugs Over-Medicate Seniors; Drive Higher Costs" Press Release, Medco Health Solutions, Inc., 5/21/03, businesswire.com
"Prozac 'Found in Drinking Water'" BBC News, 8/8/04, news.bbc.co.uk
"Fish on Prozac? How Depressing!" MSNBC, 10/23/03, msnbc.com

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