Pharmaceuticals: The egg and the hammer?
Wednesday, January 7th, 2009
If you are aged 65 years or older, then it’s highly likely you are taking a medication to treat an ageing-related condition, for 90 per cent of your peers do so. 40 per cent of you take five or more medications simultaneously and likely have been doing so for an extended time, perhaps years.
Sometimes your doctor is not fully aware of your medication program as medications are “stacked” following visits to doctors and specialists for new ailments.
Are these medications, taken dutifully at set times really doing you good and what would happen if you discontinued their use?
I’m sure many of you have a sneaking suspicion that the medications you take have waned in effectiveness and are creating problems of their own but are fearful of challenging their efficacy and the weight of medical opinion behind them.
A very well credentialled study published recently in the journal Drugs and Aging and reported in the Sydney Morning Herald suggests that not only do many drugs prescribed to the elderly contribute to hospital admissions and deaths but withdrawal from them can improve health.
Professor David le Couture, a geriatrician at Concord Hospital in Sydney and Director of the Centre for Education and Research on Ageing is a brave man intent on spotlighting the chasm between the results of drug company-sponsored medicine trials and the actual effect of these medications on the elderly.
His University of Sydney study of all previous research into medication withdrawal in older people concluded that the elderly receive no benefit from long term use of many common medicines and, shockingly, that their health may improve with discontinuation of their use.
I would imagine Professor Couture has been scratched off the Christmas list of major drug companies.
Time to withdraw?
His study found coming off drugs that affect the brain and nervous system, like sleeping pills and anti-depressants improves mental abilities and reduces the risk of falls - responsible for high rates of hospitalization and deaths in the elderly.
Blood pressure for up to 85 per cent of those 65 years or older remained stable for 6 months to 5 years after withdrawal of medication for that purpose and there was no increase in the death rate.
A typical methodology of studies reviewed by Professor le Couture was in a New Zealand study which divided those on sedatives or anti-depressants into two groups. One group continued the medication, the other group took a placebo identical in appearance. After a year the placebo group were found 66 per cent less likely to have a fall and there was no increase in the death rate.
What’s going on here? Why is futile and possibly dangerous polypharmacy the norm for nearly half the elderly?
Clearly it is in the interests of drug companies to promote the widespread and continued use of their medications but surely one’s doctor evaluates their effectiveness?
It appears that doctors are sometimes confused about which medications their patients are on and are not authoritative enough to challenge the wisdom of their intial prescription by a specialist.
To make matters worse, the elderly are not generally recruited to trial the drugs they will be prescribed and the effects of taking multiple drugs is not studied.
Clearly, it’s not in the intersts of the pharmaceutical industry to fund trials that might conclude that loading up the elderly on possibly contra-indicated drugs could be bad for them, or that weaning them off long-term use of many drugs might actually be beneficial and not make a condition worse.
Knowledge is power
By now, you have picked up that I favour a preventative approach to health in ageing but I do acknowledge that modern pharmacology is a useful tool in prolonging life in those who have developed ageing-related conditions. However, with the resources of the Net at everyone’s disposal it is time the patient empowered him or herself with information about the medicines doctors prescribe.
In a recent, and admittedly petty example, I took the trouble to research several of the ingredients in my “natural”, “Ayurvedic” herbal Indian toothpaste. I love it’s chalky, cleansing texture and myriad aromatic herbs, from Asian Holy Oak to Catechu. But Sodium Laurel Sarcosinate, Sodium Saccharin and Methyl Hydroxy Benzoate Sodium? Where do these scary-sounding ingredients fit into the “natural” spectrum?
It turns out SLS is a foaming agent frowned upon by some researchers and Saccharin is an artificial sweetner banned for decades in most Western countries due to studies linking it to cancer in rats. Nice. And MHBS? A toxic preservative also banned in many countries.
I’ve been dipping my “natural” toothpaste into soda bicarb for extra cleaning power and when the current tube runs out I’ll be using it exclusively to brush my teeth, maybe adding a few drops of peppermint oil.
I emailed the company in India asking them to reconcile their “natural” claims with the undesirable characteristics of these industrial ingredients but they chose not to reply.
My point is - do not trust companies with a profit motive to care for your health without empowering yourself with information first. In the case of medication I recommend you find a sympathetic doctor who will consider monitoring you as you withdraw from some or all of the medications you currently take.
At least until elements of the pharmaceutical/medical industry take a more analytical and sympathetic approach to prescribing drugs to the elderly. Currently it appears the use of some medications can only be likened to using a hammer to crack an egg.
Help from the human genome
Recent developments that marry human genomics to pharmaceutical prescription may improve or fix the problem.
The Australian Government is considering funding tests to target drugs at the right patients, reduce harmful side effects, and promote the saving of billions of dollars in the process.
Pharmacogenomics aims to use individualised tests for patient biomarkers to test effects of drugs on patients. Individuals respond differently to drugs. You either respond as predicted or you wind up in hospital with severe side effects.
Some drugs identified in the study are those prescribed to the elderly for colorectal cancer, anti-coagulant stroke prevention, cholesterol-lowering and anti-depression.
Let’s hope the elderly will be included in studies and trials this time.
