Drug Pushers

[30A Skunkape]

I am just now seeing this thread.

Mike, I am sorry for your tragedy. With that said, I know you are an emotional man and ask that you step back and perhaps rethink the situation before you blast this doctor, and basically all his/her peers, with both barrels. I find it somewhat curious that you have labelled the provider in question a 'pusher' when he/she had seemingly taken care of your mom for years without 'pushing' anything on her. Providing care to the very elderly is tricky, and there may be factors that were in play that even you are unfamiliar with. Sometimes narcotics are the right answer for people with severe pain and are less harmful than ibuprofen. Sometimes there are issues with kidney function or the stomach which make ibuprofen the wrong choice and a narcotic a much safer choice! With that said, anything that leads to altered mental status should generally be avoided or used with caution in the elderly. My point is that I have a feeling there is probably more to the decision than even you might be aware of, and you might be guilty of ignoring the concept of 'first doing no harm' by bashing the hell out of a whole profession.

Are there pushers in the medical community? Yes, without a doubt. There are providers who will dispense inappropriate pain medication for cash. Our local pusher, Dr Webb in Destin, went down last year and will probably live his life out in jail. That is good. Just below the pushers on the sleaze ladder are the quacks who take cash in exchange for performing bizarre tests and offering unproven remedies, often soaking desperate people for substantial sums. We have more than our fair share in this area. I had lunch with one of Florida's Attorney General candidates a few months back, and I asked that he make it a priority to rid Florida of the menace providers, be they quacks or drug pushers.

It might also surprise you that most likely whatever was given to your grandfather was generic and not marketed by any pharmaceutical company bunnies. The drug companies are a whole other topic, and briefly, your comments are on the money.

 

[sunspotbaby]

Mike, your story made me cry. I'm so sorry that your grandfather is going through this and that his family is struggling to find answers. It sucks to be in this position. I know. I was there not long ago with my Dad. Thankfully he is no longer suffering at the hands of people who didn't know him or care about him. They were successful at one thing...killing him.

Again, i'm sorry. He sounds like one hell of a man to know and love.

 

[mikecat adjuster]

I am just now seeing this thread.

Mike, I am sorry for your tragedy. With that said, I know you are an emotional man and ask that you step back and perhaps rethink the situation before you blast this doctor, and basically all his/her peers, with both barrels. I find it somewhat curious that you have labelled the provider in question a 'pusher' when he/she had seemingly taken care of your mom for years without 'pushing' anything on her. Providing care to the very elderly is tricky, and there may be factors that were in play that even you are unfamiliar with. Sometimes narcotics are the right answer for people with severe pain and are less harmful than ibuprofen. Sometimes there are issues with kidney function or the stomach which make ibuprofen the wrong choice and a narcotic a much safer choice! With that said, anything that leads to altered mental status should generally be avoided or used with caution in the elderly. My point is that I have a feeling there is probably more to the decision than even you might be aware of, and you might be guilty of ignoring the concept of 'first doing no harm' by bashing the hell out of a whole profession.

Are there pushers in the medical community? Yes, without a doubt. There are providers who will dispense inappropriate pain medication for cash. Our local pusher, Dr Webb in Destin, went down last year and will probably live his life out in jail. That is good. Just below the pushers on the sleaze ladder are the quacks who take cash in exchange for performing bizarre tests and offering unproven remedies, often soaking desperate people for substantial sums. We have more than our fair share in this area. I had lunch with one of Florida's Attorney General candidates a few months back, and I asked that he make it a priority to rid Florida of the menace providers, be they quacks or drug pushers.

It might also surprise you that most likely whatever was given to your grandfather was generic and not marketed by any pharmaceutical company bunnies. The drug companies are a whole other topic, and briefly, your comments are on the money.

Generally, a well thought out message. You make some good points. I I just wanted to point out that I wasn't bashing the entire profession. I was just pointing out that people should be very aware of what they put in their bodies because many doctors have become so accustomed to dolling it out. And yes, patients have begun to expect it, kinda like with anti-biotics.

I know someone who was invloved with dispensisng of drugs online. He made millions and millions btw. But he is now doing time while the doctors who wrote tens of thousands of prescriptions did not recieve has harsh a punishment. To me, it seems like the guy running the business could have said, 'Hey, I employee these doctors who take an oath. If they prescribed in an illegal way, then punish them, not me.'

Anyway, I'm just pointing out that too many people see a halo around a doctors head when they need to look beyond the white coat and see them for what they are. I love good doctors and have known some. A good doctor is like a good mechanic, except their excellence saves lives.

But like mechanics, some suck. And when their is an incentive to push drugs, the ratio of bad ones is increased over what it would be based on general incompetence alone.

 

[Gidget]

Exactly Mike. Heaven knows there are wonderful doctors and other health care workers and I send them a HUGE .

But we must be very vigil when it comes to seniors. Case in point. My father in law. At 80 he had elevated cholesterol. Mind you there was NO history of heart disease in his family, he had low blood pressure and his ratios - HDL/LDL were fine - also, he was thin. YET his primary care physician told him he needed to get on Lipitor. Well, that was the beginning of the end. He became weak, his leg muscles were atrophying and he was deteriorating. I did some research and found hundreds of people in the same condition from statins. And the big point here is that statins are NOT tested on the elderly. Their bodies are different and don't stand up to the same dosage that is tested on adults. Statin side effects are not rare yet when we brought up his muscle weakness he got very defensive saying that his doctor wouldn't put him on something that would "do harm." I insisted he get off and finally he listened and he became a lot better. Only next time he went back to the dr., he chastised him and well, he got back on. He got worse again. My dh and I were outraged, printed and faxed a study regarding elderly and statins and pretty much told the dr not to ever push that on him again. Instead, he gave him an osteoporosis drug (at 80) that burned his esophagus to the point where he had trouble swallowing. Therefore, he ended up with a feeding tube and ended up ultimately having such "back up" issues into his lungs that he died from those complications. My point is that this attempt to correct every symptom is ludicrous - especially in the elderly. Neither one of these issues had to even be treated by meds on a man at 80. Some red yeast and a few tweaks on the diet and a program of light weights and walking would have been great for his bones.

I could tell you my father's story - but that's another time....

G

 

[GoodWitch58]

and you can often tie these incidents back to insurance -medicare or otherwise. The coverage almost never includes preventive, or exercise, or any of the things that might help in this case.

But, it will pay for tests and drugs, so the doc does what can be reimbursed.

The current system puts everyone at risk except the insurance and drug companies, IMO. (maybe the doc if the patient's family choose to file a wrongful death)

 

[30A Skunkape]

Exactly Mike. Heaven knows there are wonderful doctors and other health care workers and I send them a HUGE .

But we must be very vigil when it comes to seniors. Case in point. My father in law. At 80 he had elevated cholesterol. Mind you there was NO history of heart disease in his family, he had low blood pressure and his ratios - HDL/LDL were fine - also, he was thin. YET his primary care physician told him he needed to get on Lipitor. Well, that was the beginning of the end. He became weak, his leg muscles were atrophying and he was deteriorating. I did some research and found hundreds of people in the same condition from statins. And the big point here is that statins are NOT tested on the elderly. Their bodies are different and don't stand up to the same dosage that is tested on adults. Statin side effects are not rare yet when we brought up his muscle weakness he got very defensive saying that his doctor wouldn't put him on something that would "do harm." I insisted he get off and finally he listened and he became a lot better. Only next time he went back to the dr., he chastised him and well, he got back on. He got worse again. My dh and I were outraged, printed and faxed a study regarding elderly and statins and pretty much told the dr not to ever push that on him again. Instead, he gave him an osteoporosis drug (at 80) that burned his esophagus to the point where he had trouble swallowing. Therefore, he ended up with a feeding tube and ended up ultimately having such "back up" issues into his lungs that he died from those complications. My point is that this attempt to correct every symptom is ludicrous - especially in the elderly. Neither one of these issues had to even be treated by meds on a man at 80. Some red yeast and a few tweaks on the diet and a program of light weights and walking would have been great for his bones.

I could tell you my father's story - but that's another time....

G

Polypharmacy is a huge problem with the elderly. I frequently get new patients who have been moved down here by their kids to be closer. Some of their drug lists are staggering. Less is almost always more with the elderly and it sometimes takes two or three visits to whittle it down to something reasonable.

I would like to discuss one thing you mention above that I encounter frequently. Many people take red yeast rice for cholesterol. I ask them (nonthreateningly, of course) what motivated them to make that choice and whether or not they know the mechanism by which red yeast rice (potentially) lowers cholesterol. Without exception, it has to do with a fear of statins (Lipitor, Crestor, Zocor, etc) and a desire to be 'more natural', and I have YET to have a SINGLE user of the RYR know anything about the product's pharmacology. It is interesting to see their reaction when I explain that red yeast produces lovastatin at some point during the organism's metabolism and this is the ingredient thay are ingesting that lowers cholesterol! Zooiks! It does not sound like the case with your grandfather, but I would say that if someone truly has hyperlipidemia not improved by diet and exercise that requires medication, RYR is a terrible strategy as the amount of active ingredient (the statin) is probably trivial (or potentially high!) and varies from dose to dose. If one is going to go through the trouble of taking something, it makes much more sense to go ahead and use a statin (or Niacin for that matter) where the product taken is a known entity. And no, it does not have to be lipitor-there are currently two excellent statins available at Wal-Mart for $4 a month, which is an incredible value when you compare the efficacy of the product and the price (go try to buy a botlle of red yeast rice for $4!).

 

[seacrestgirl]

Without delving to deep into this controversy, I want to add some tips that will definitely help medical providers care for an elderly patient:

• Polypharmacy is the biggest threat to an elderly patient. It is crucial that geriatric patients maintain a relationship with a primary provider. Often, geriatric patients are managed by a host of specialists. There needs to be one primary provider whose job is to look at the whole picture. Medications react with each other and elderly patients are not able to metabolize meds as well as younger adults. It is often these medication reacting with each other that pose a danger.

• It is imperative that an elderly patient (or any patient, for that matter) keeps a written list of medications to take with them to each medical visit. This list should include the medication name, strength, dosing times, who prescribed the medication and when the medication was started. This will greatly help any medical provider see the big picture. Patients tend to forget a medication or two when asked to verbally present their list of meds in the office.

• It is important that older adults see a primary provider who has some experience with geriatric patients. Doesn't have to be a geriatrician, but one should inquire about geriatric experience.

• Please remember that medicine is complicated, especially when dealing with older adults. There are many over the counter medications that are high risk for older adults, not just prescribed ones. All of us need to become more vigilant as patients. We need to pay attention, ask questions and most importantly, become more active in our own health maintenance.

 

[GoodWitch58]

I would like to discuss one thing you mention above that I encounter frequently. Many people take red yeast rice for cholesterol. I ask them (nonthreateningly, of course) what motivated them to make that choice and whether or not they know the mechanism by which red yeast rice (potentially) lowers cholesterol. Without exception, it has to do with a fear of statins (Lipitor, Crestor, Zocor, etc) and a desire to be 'more natural', and I have YET to have a SINGLE user of the RYR know anything about the product's pharmacology. It is interesting to see their reaction when I explain that red yeast produces lovastatin at some point during the organism's metabolism and this is the ingredient thay are ingesting that lowers cholesterol! Zooiks! It does not sound like the case with your grandfather, but I would say that if someone truly has hyperlipidemia not improved by diet and exercise that requires medication, RYR is a terrible strategy as the amount of active ingredient (the statin) is probably trivial (or potentially high!) and varies from dose to dose. If one is going to go through the trouble of taking something, it makes much more sense to go ahead and use a statin (or Niacin for that matter) where the product taken is a known entity. And no, it does not have to be lipitor-there are currently two excellent statins available at Wal-Mart for $4 a month, which is an incredible value when you compare the efficacy of the product and the price (go try to buy a botlle of red yeast rice for $4!).

Such good advise, thanks Dr. S. I had this very situation and once I explored it, realized that was not a good option and researched another treatment. This was after having a real problem with Lipitor.

Elderly patients really need an advocate. I have found with my parents they are so conditioned to believe the "authority" whether it's a doctor, lawyer, merchant chief, etc...they often will not ask questions, or sometimes won't even believe that they should question. IMO most docs are well being and do the right thing--of course, there are those others....

 

[GoodWitch58]

Without delving to deep into this controversy, I want to add some tips that will definitely help medical providers care for an elderly patient:

• Polypharmacy is the biggest threat to an elderly patient. It is crucial that geriatric patients maintain a relationship with a primary provider. Often, geriatric patients are managed by a host of specialists. There needs to be one primary provider whose job is to look at the whole picture. Medications react with each other and elderly patients are not able to metabolize meds as well as younger adults. It is often these medication reacting with each other that pose a danger.

• It is imperative that an elderly patient (or any patient, for that matter) keeps a written list of medications to take with them to each medical visit. This list should include the medication name, strength, dosing times, who prescribed the medication and when the medication was started. This will greatly help any medical provider see the big picture. Patients tend to forget a medication or two when asked to verbally present their list of meds in the office.

• It is important that older adults see a primary provider who has some experience with geriatric patients. Doesn't have to be a geriatrician, but one should inquire about geriatric experience.

• Please remember that medicine is complicated, especially when dealing with older adults. There are many over the counter medications that are high risk for older adults, not just prescribed ones. All of us need to become more vigilant as patients. We need to pay attention, ask questions and most importantly, become more active in our own health maintenance.

A whole bunch more reasons why Drug Companies Should Not Advertise Drugs on TV, Radio and in popular magazines! If they put that money into research, we would have more cures/vacines/etc., than we do, and fewer people sick and dying from drug interaction complications!

 

[30A Skunkape]

Without delving to deep into this controversy, I want to add some tips that will definitely help medical providers care for an elderly patient:

• Polypharmacy is the biggest threat to an elderly patient. It is crucial that geriatric patients maintain a relationship with a primary provider. Often, geriatric patients are managed by a host of specialists. There needs to be one primary provider whose job is to look at the whole picture. Medications react with each other and elderly patients are not able to metabolize meds as well as younger adults. It is often these medication reacting with each other that pose a danger.

• It is imperative that an elderly patient (or any patient, for that matter) keeps a written list of medications to take with them to each medical visit. This list should include the medication name, strength, dosing times, who prescribed the medication and when the medication was started. This will greatly help any medical provider see the big picture. Patients tend to forget a medication or two when asked to verbally present their list of meds in the office.

• It is important that older adults see a primary provider who has some experience with geriatric patients. Doesn't have to be a geriatrician, but one should inquire about geriatric experience.

• Please remember that medicine is complicated, especially when dealing with older adults. There are many over the counter medications that are high risk for older adults, not just prescribed ones. All of us need to become more vigilant as patients. We need to pay attention, ask questions and most importantly, become more active in our own health maintenance.

Great points, and I might expand the hi-lighted point above. Forget the list, BRING THE BOTTLES to the visit! The advantage of this is that any ambiguity about what is being taken is eliminated. Even lists get chaotic without meticulous documentation. There is no question as to the prescriber, dosage, timing, etc. if the label is available. Also, seniors tend to amass pill bottles;I don't know if it is frugality or what, but they frequently hold on to medications that have been discontinued. A clinic is a great place to unload these unused medications as they really are hazardous waste if you think about it, and clinics are capable of disposing of such properly. I like to throw the unused medication away right then and there so as to prevent confusion down the road or accidental ingestion by kids. I also find it helps to jot a note on the labels like 'blood pressure' or 'diabetes' to help people understand what the medication's purpose is.