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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 prescriptions, 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 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.
Here are some easy
recommendations:
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Be
patient with your symptoms and your symptoms may become
patient with you.
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Avoid
sleeping pills, pain pills and nerve pills IF possible.
They have a lot of side effects and usually don't cure
the problem.
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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).
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Minimize
the variety and quantity of optional, non-prescription
drugs you take.
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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.
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Update
your list every time you see a new doctor; change, add,
or subtract medications, and alter dosages.
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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.
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Your
physician should likewise keep a copy of your medication
list.
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Try
to minimize the number of pharmacies used and keep your
pharmacist up to date.
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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.
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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.
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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.
American
Association of Physicians And Surgeons
February 1, 2001
Michael Arnold Glueck, MD, Newport Beach, Calif.,
has written extensively on medical and legal reform issues.
1208 Somerset Lane
Newport Beach, CA 92660
949.645.5183
E-Mail:72143.2077@compuserve.com
Robert J Cihak, MD of Aberdeen, Wash., is president
of the Association of American Physicians and Surgeons.
547 Fairway Drive
Aberdeen WA 98520
Phone: 360 533-5017 Cellular phone: 503 939-5470
FAX: 801 720-0701
E-Mail: RCihak@techline.com
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