How many prescription medications are you taking? How many over-the-counter herbal medications or other nutritional supplements? The alarming results of a new study on the combinations of medications taken by American seniors indicate that it’s best to be cautious about taking certain prescription and over-the-counter medications in tandem.

According to the report—which reviewed the medications taken by 3,000 men and women aged between 57 and 85—at least two million older Americans might be taking a potentially dangerous combination of prescription or over-the-counter medications. And up to one in ten older men might be taking a combination of drugs which could be potentially harmful.

Another factor affecting seniors is the fact that older people tend to take more medications overall, including both prescription and over-the-counter preparations. In the 57 to 85 age group, 91% of people take at least one medication, and more than half use five or more medications, including prescription and over-the-counter drugs.

The consequences of drug combinations aren’t always dangerous, but for older people, the side effects and interactions of drugs and over-the-counter medications are often more hazardous, due to the way metabolism changes as we age.

An example of a potentially serious drug interaction is that between warfarin, which is used to dissolve blood clots, and aspirin, which has a similar blood-thinning effect. The risk of internal bleeding can become dangerously high when both drugs are taken together. The combination of warfarin and garlic can also have a similar effect.

Other potentially dangerous combinations include:

• Aspirin and gingko biloba, taken together, can increase the risk of excessive bleeding.
• Taking Lisinopril (prescribed for blood pressure), along with potassium supplements (which may be prescribed because some blood pressure drugs reduce potassium levels), can cause abnormal heart rhythms.
• Over-the-counter niacin supplements can be dangerous when taken with statins (prescribed for managing cholesterol levels), due to an increased potential for muscle damage.

Experts say it’s best to be cautious when it comes to over-the-counter medications – don’t take them without the ok from your doctor, and make sure you ask about side effects and drug interactions every time your doctor prescribes a new medication.

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Many of us are predisposed towards a mistrust of drug companies. The fact is, they make billions of dollars every year, and it seems like most would do anything for a buck. Recent news that AstraZeneca allegedly suppressed negative information about Seroquel, an anti-psychotic drug, is not helping the tarnished image that the pharmaceutical industry has earned.

A Washington Post article published recently outlines the study, known as “Study 15,” and reported that AstraZeneca had suppressed the study’s negative results, and at the same time promoted more positive results from other studies with less stringent protocols.

Also reported by the Washington Post: The shocking fact that one employee of AstraZeneca praised a colleague’s “smoke and mirrors job” in reference to the suppression of the negative results. Those suppressed results include a possible link between Seroquel and the development of diabetes. In addition, the study showed that Seroquel was no better than other anti-psychotic drugs at preventing psychotic relapses.

Who To Trust With Your Health And Prescription Drugs

Sometimes, it’s hard to know who to trust. And unfortunately, some doctors can’t be trusted when it comes to clinical trials either.

Dr. Scott Reuben, an anesthesiologist currently on leave from Springfield’s Baystate Medical Center in Massachusetts, has been accused of faking data in clinical trials for a staggering twelve years. According to the accusations, Dr. Reuben is responsible for faked data in no less than 21 published medical papers.

• According to news released by the Baystate Medical Center, a routine hospital review carried out in 2008 revealed that some of the doctor’s research had not been approved by the hospital’s review board.
• An investigation into the issue found that Reuben had made up some or all of the data in 21 papers published over the last twelve years.
• The data involves several drugs, including Celebrex, Lyrica, and Effexor, and Reuben attests to their effectiveness as painkillers in the published studies.

On the basis of the studies, Reuben had received numerous research grants from several sources, including drug company Pfizer, which makes and markets Celebrex.

As if the monetary rewards weren’t bad enough, the doctor has become widely respected in the field of anesthesiology on the basis of his fraudulent research, and many doctors have been basing their own use of pain relievers on Reuben’s results.

And even worse for patients, some of the drugs Reuben “studied” have been shown to delay bone healing – but Reuben’s work didn’t show up any of those problems. It’s now likely that many of the clinical trials Reuben published will be redone to ensure that accurate results are achieved.

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President-elect Barack Obama should take note – health reform is about the little things just as much as it is sweeping changes to the system.

Information gathered from a batch of more than 8,500 meetings held around the country in December will be compiled and used to help design the healthcare proposal that has been in the news as of late. Obama’s transition team plans to post some of the material at change.gov.

One particular meeting took place late December 2008, between newly appointed secretary of health and human services, the former Senate Majority Leader Tom Daschle, and more than two dozen seniors During this meeting, seniors told Daschle that they placed more importance on certain things such as waiting times to see their doctor, the increasing cost of prescription drugs, and the narrow range of Medicare coverage for certain medical procedures, equipment, and treatments.

An Example for Health Care Reform: Alzheimer’s

One woman at the meeting cited her family’s history of Alzheimer’s disease for her hope that the new administration will put heavy emphasis on medical research. A man said that helping people live healthier lives should receive more emphasis than it currently does – not only to improve health, but also to reduce medical costs for individuals and the nation as a whole. Another man says he wants medical providers to show more concern for the people they treat than whether or not those people will pay their medical bills.

Daschle says that lawmakers are more likely to get behind a new health care system if voters provide enough incentive pressure. And it seems that the transition team is listening: The Obama administration is encouraging seniors to submit their own stories about health care – and any other issues they think need to be addressed.

The team should also take one final note: The current effort to gather information about the health care system has been compared to the 2005-2006 attempt by the Citizens Health Care Working Group. More than 6,500 people participated in meetings across America, and a further 14,000 participated in online surveys. The Congress-sponsored group eventually recommended guaranteed health coverage for certain doctor’s visits, and some ways to protect people from high health care costs – but none of its recommendations were acted upon.

Let’s hope that this new round of meetings prompts some real change.

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Fibromyalgia is a devastating disease that causes chronic pain and other symptoms for those who are affected – but it’s a disease with no known cause and no standard treatment. Many people haven’t even heard of the condition, but if that’s the case it’s not because the drug industry isn’t trying hard enough.

Drug Companies’ Hundreds of Millions Help Raise Awareness of Fibromyalgia

Last year, drug industry giants Pfizer and Eli Lilly spent hundreds of millions of dollars in advertising to “raise awareness” of fibromyalgia. The companies donated more than six million dollars to non-profit organizations for educational campaigns and medical conferences, too.

That’s more than the companies donated for Alzheimer’s, and diabetes. And only donations made for cancer, depression, and AIDS were higher than the donations made to further the cause of fibromyalgia.

Why all this trouble for a disease nobody’s heard of, that some doctors don’t even believe exists? Simple. Pfizer and Eli Lilly are using their money and influence to “raise awareness” and get doctors prescribing fibromyalgia drugs for people with the disease.

Is Fibromyalgia Real? Why the Sudden Drug Company Interest?

Fibromyalgia is a real disease, especially to those people who are affected by it. But there’s no standard treatment – just a couple of drugs more commonly used to treat other conditions which improve symptoms for some people with fibromyalgia.

Pfizer markets a drug called Lyrica, which originally received FDA approval for the treatment of epileptic seizers. Eli Lilly’s drug, Cymbalta, was originally approved for depression. Both have now been FDA-approved to treat fibromyalgia symptoms and will probably soon be appearing on the formulary lists of prescription drug plans, if they haven’t already.

Sales of the Fibromyalgia Prescriptions since Big-pharma’s Campaign

Since the companies began marketing “awareness” for fibromyalgia, sales increased from $395 million to $702 million for Lyrica, and from $442 million to $721 million for Cymbalta, between 2007 and 2008. Each company spent just over $125 million in advertising its drugs in the first nine months of 2008.

Now this might not necessarily be a bad thing. After all, people with this chronic, painful condition are getting treatment that they need.

The problem, however, is that the underlying purpose for Eli Lilly and Pfizer is simply selling drugs, and some healthcare professionals are concerned that undue influence from the pharmaceutical industry will pressure doctors into diagnosing fibromyalgia more often, even if it might not be appropriate.

In addition, some doctors believe that fibromyalgia, while a real condition, isn’t necessarily physical – that there may also be a psychological or neurological component in the development of the disease. If that’s the case, the drugs that Pfizer and Eli Lilly are pushing may not be the best solution for people with fibromyalgia.

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The close ties between doctors and the drug industry are long-standing, but recently health policy experts have been saying that it’s about time those ties were cut. Over the years, many reports of drug companies providing financial and material perks for doctors has caused an erosion of public trust in medical professionals – and experts say that to repair that particular problem, it’s time for doctors to cut ties with the drug companies that provide the kick-backs.

A series of comments made by health policy experts in the British Medical Journal elaborate on the issue, saying that doctors might have to give up the freebies to win back public trust. From inexpensive prescription pads and pens to seminars at luxurious hotels, there are plenty of rewards for doctors who cultivate good relationships with drug companies.

Benefits of Winning Doctors’ Favor go to the Drug Industry

For the drug industry the benefits are obviously massive, especially so considering recent reports indicate that TV drug advertising is less effective these days than in the past at selling name-brand prescription drugs. That means drug companies are relying more than ever on doctors to prescribe the drugs the companies sell, and offering perks to doctors is the traditional method companies use to get more products sold.

Last year, however, concerns over the relationship between doctors and the drug industry increased after Iowa Senator Charles Grassley accused Harvard University psychiatrist Dr. Joseph Biederman, and other doctors, of failing to disclose payments they had received from certain drug companies.

Solutions to the Drug Industry Payola Problem

According to Dr. Marcia Angell of Harvard Medical School in Boston, the best solution is for doctors to simply cut their ties to the drug industry, once and for all – to stop accepting even the smallest gifts, and to recognize that their prescribing habits might be biased towards the companies they received those gifts from in the past.

Angell believes that instead of attending those cozy drug company-funded seminars, doctors should take personal responsibility for keeping up-to-date with their medical education. And, she says, professional associations shouldn’t allow drug companies to fund publications and meetings.

The meetings might be held in less luxurious surroundings, says Angell, but the results would be preferable, with more emphasis placed on impartial medical education rather than drug companies furthering their own agendas to sell more drugs.

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Off-label prescribing—the practice of prescribing medication for a condition for which it is not indicated or approved—is very common in America, particularly in the treatment of psychiatric disorders. In 2001, an estimated 21% of prescriptions for the 160 of the most commonly-used drugs were off-label.  And 75% of those off-label prescriptions were written for conditions for which there is absolutely no scientific evidence to prove they work!

The law doesn’t prevent this practice, although it does prevent pharmaceutical companies from promoting off-label prescribing. Often, there’s no real harm in off-labeling, but equally so, there’s even more often no scientific proof that those off-label drugs are doing you any good. The only evidence is what’s called anecdotal – evidence that has been noted by doctors, but there has been no scientific study carried out to provide hard proof.

Doctors and law-makers know it’s a problem, but they say it’s such an extensive issue that they just don’t know how to even begin solving it. This December, however, that might be about to change, as a group of physicians will publish a paper in scientific journal Pharmacotherapy, about ways in which solutions to the off-labeling problem might be approached.

The researchers who studied the issue have identified a list of fourteen medications that are often prescribed for off-label uses. Many of the drugs on the list are antidepressants and anti-psychotics – drugs used to treat psychological problems. Six of the drugs on the list are used to treat bipolar disorder. All three of these represent categories of illness where both physicians and their patients are eager to try new solutions and off-label prescriptions.

Often, this can provide an effective means of treatment for people with psychological disorders – but the problem is, these drugs haven’t been FDA tested and approved for the uses to which they are put. That means a serious risk of unintended and unanticipated side effects, which in turn can endanger the life and safety of the patient.

An additional problem is that drug companies are reluctant to put their products through the testing required for off-label uses, not only due to the expense, but also because testing might prove the existence of undesirable side effects that might make the drugs less popular for off-label use.

The solution? The researchers and physicians who have studied the off-label issue have proposed that an extensive round of testing and surveying be conducted on the fourteen drugs identified as being most commonly used for off-label purposes. They also say that patients should be proactive and ask their doctors for more information about the medications they are prescribed.

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Proponents of increased efficiency in healthcare have long been advocating electronic prescriptions, and it looks like they’re about to start making some headway with that goal. Beginning January 2009, doctors who use electronic prescriptions will be eligible for bonuses from Medicare.

Paperless prescriptions are those that don’t involve any print-outs. It doesn’t count, for example, if your doctor writes your prescription on a computer then gives you a print-out, or if your prescription is faxed over to the drugstore. A true paperless prescription is exactly what it says: no print-outs at all.

In 2007 around 35,000 doctors were writing e-prescriptions (although many of these continued to use paper prescriptions as well), and an estimated 70,000 have been using paperless prescriptions in 2008.

For many doctors, the cost of setting up the system is something of a stumbling block, however. A doctor wanting to set up the system will need to spend around $3,000. The hope is that the Medicare bonus will offset the cost and tempt more doctors to use the system. For the next four years, the average doctor can earn a bonus of $1,000 to 1,500 per year by using the system (the bonus is in effect until 2012).

Benefits of E-Prescribing

The benefits of such a plan are wide-ranging. The most significant is in terms of safety. More than 1.5 million are harmed in some way by medical errors every year, some of which result from prescription errors.

An electronic prescribing system can reduce the possibly of such errors occurring in several ways. First, the possibility of a pharmacist misreading a doctor’s handwriting is completely eliminated. More importantly, an electronic prescribing system can flash an onscreen warning if a prescription seems to include drugs that might cause a dangerous interaction with others the recipient is taking, or if the dose seems to be inappropriate.

The hope is that this and other measures to improve medical efficiency and billing systems will result in savings of millions of dollars per year. This is a key part of President-Elect Obama’s plan to reform the healthcare system. Making the move to computerized medical records in addition to prescriptions could mean even more significant savings, as well as vastly improved billing systems.

Another advantage is for the patients, in cases where doctors have a choice of similar drugs to prescribe. Insurance companies tend to categorize their drugs into different tiers, with different levels of co-payment, and an e-prescribing system can alert doctors to the cheaper options for their patients.

Finally, there’s the fact that all of this improved efficiency should mean shorter waits for people getting prescriptions filled. So in this case it looks like everybody wins.

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Physicians have recently come under fire as a result of a study which showed that half the doctors in America are in the habit of prescribing placebos – drugs which don’t actually do anything. They’re prescribed to patients to make them feel as though something is being done to help their condition. Often, people experience better health simply because they’re mind believes that the drug is helping their condition, when the drug actually has no physiological effects.

However, there is actually another concern about prescribing medications that is far more serious, and even has the potential to be harmful, not to mention needlessly expensive, even if you have a dedicated prescription drug health insurance plan; this is a habit many doctors have called off-label prescribing.

Off-label prescribing is the practice of prescribing a medication for a purpose for which it is not intended or approved. The FDA approves drugs for certain purposes – but once the drug is approved, they don’t regulate its use. This means doctors can, and do, prescribe drugs to be used in ways which haven’t been approved. With a few notable exceptions, this process is at best just more pointless (and needlessly expensive) prescribing of placebos.

Statistics for Off-label Prescriptions

In 2001, American doctors wrote a whopping 150 million off-label prescriptions – drugs being used to treat conditions other than those which are FDA-approved. That’s 21% of all prescriptions for 160 of the most commonly-used medications in the country. For drugs used in the treatment of psychiatric issues, it’s a little over 30%.

And here’s another staggering statistic: about 75% of all the off-label prescriptions were used to treat conditions for which there is virtually no scientific evidence to prove they work. Often, off-labeling is done on the basis of anecdotal evidence, rather than scientific studies.

The thing is, in the eyes of the law, there’s no problem: it’s illegal for drug companies to promote drugs for off-label prescribing, but it’s not illegal for doctors to prescribe off-label drugs. And obviously, drug companies don’t think it’s unethical that their drugs are used in this way (of course, if drug companies discourage off-labeling they’ll lose a big chunk of revenue, so naturally they’re not going to discourage it).

Off-Label Drugs and You

So what’s the message for the consumer? Be cautious when your doctor’s prescribing medications. Off-labeling isn’t necessarily something that’s going to hurt you, but there’s definitely no harm in asking your doctor for more information about the medications they’re giving you – especially when you, or your insurance, is footing the bill. If your off-label medication is just another placebo, you don’t need it.

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For various reasons, the Western world has become increasingly reliant on medication to preserve health. It’s not uncommon for people to receive more and more prescriptions as they age: a full twenty percent of people over 65 take ten or more prescription medications regularly. So what’s the problem – those pills are helping you stay healthy, aren’t they?

The problem is, that’s not necessarily true.

An Avalanche of Prescriptions

Health care coverage for chronic diseases tends to shunt people off to multiple doctors – according to statistics from the Agency for Healthcare Research and Quality, 81% of people with a chronic condition see two or more doctors – more than half have three or more, and around a third have four or more.

And if you see a specialist, they don’t necessarily know what your previous doctors have prescribed. Your primary care physician is supposed to oversee your medical care, but they tend not to question specialist decisions – and over the last decade or two, prescribing medication has become the standard way of treating almost any ailment, regardless of whether there are other solutions. With insurance companies preferring to pay up for medication rather than any other option, it’s no wonder that over-prescribing is rampant.

The Snowball Effect: Over-use of Prescriptions

So what are the consequences of taking ten or more prescription medications every week, or every day?

One of the most dangerous effects is the possibility that a toxic drug reaction may result from a certain combination of medications – an increasingly likely prospect for someone who has two, three, or four doctors, any one of whom may not necessarily know what the other three are doing. Those reactions can lead to the development of new symptoms – caused by the drugs – for which your doctor may even prescribe yet more medication.

This is an especially potent problem for seniors: as we age, we begin to absorb and metabolize drugs differently. A dose which might be safe for a young person might very well be toxic in someone thirty years older.

When you add these two issues together, the results can be dangerous. An estimated 1.5 million adverse drug reactions occur in the U.S. every year; around a third occur in seniors.

So what’s the solution here? It’s pretty simple: take control of your health. Talk to your doctor, and ask them about any lifestyle or other changes you can make that might alleviate your need for prescription medications.  In many cases, lifestyle changes might allow you to throw away some medications for good.

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Prescription medications are expensive, and many doctors seem to become “prescription-happy.” These doctors’ first response to a patient complaint is usually to prescribe something new if something doesn’t work the first time. Even if you’re just taking one or two medications, you could be paying more than you need if you are taking brand name drugs, instead of generics.

According to a recent study, led by Dr. Aaron Kesselheim of Brigham and Women’s Hospital and Harvard Medical School in Boston, this is particularly true when it comes to medications prescribed for the treatment of heart and cardiovascular conditions. According to the researchers, there is no evidence to suggest that brand name drugs work any better than their generic counterparts.

The Brand Name vs. Generic Debate

What exactly are generic drugs? They’re drugs on which the patent has expired. When a pharmaceutical company develops a new drug, they hold the exclusive patent on that drug for a certain number of years. After that time, the exclusive rights are lost, meaning that other companies can manufacture the drug under a different name. These are termed generic drugs, because they are no longer associated with the brand name company which originally developed them.

The new generic drug might have a different shape and color, or may have different fillers or binders added to the active ingredients. In most cases, however, there is no difference at all in how well the generic drug works in comparison to its brand name counterpart. Big-name pharmaceutical companies have gone to extensive lengths to try and prove that generic drugs are inferior, but the results of the new study suggest that’s just not true.

So what’s the difference between brand name drugs and generic drugs? Just one thing – the cost. The cost per pill of a brand name medication might be a few dollars, but for a generic drug prescribed for the same purpose, the cost might be only a few cents. While 66% of drugs prescribed in America are generic, they account for less than 15% of the money spent on all prescription drugs.

This doesn’t mean, however, that you should rush to your doctor and demand that they prescribe only generic drugs for you. It’s always most important that you receive the medications your doctor feels will work best for you – whether brand name or generic. Although, of course, if you’re taking an expensive brand name medication, there’s no reason why you can’t ask your doctor if there is a cheaper generic alternative that might work just as well.

What the research really shows is that if you’re taking medication for a heart or cardiovascular condition, you can feel secure whether it’s brand name or generic. You don’t have to worry that your treatment is inferior just because you’re taking an inexpensive generic medication.

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