Map of life expectancy at birth from Global Education Project.

Tuesday, August 30, 2011

Goddamn the pusher

For you young uns, that's a song by written by Hoyt Axton and performed by Three Dog Night, [right, Steppenwolf, thanks to a commenter. Axton did write for TDN] IIRC. As I recounted here a while back, when my father was in an assisted living facility with moderate dementia, my mother came to visit one day and found him slumped in a chair, drooling, and incoherent. It turned out they had given him "Abilify" (the most noxious and mendacious brand name in all the pharmaceutical industry). It's an antipsychotic that has a black label warning against giving it to elderly people for dementia because a) it doesn't treat dementia and b) it kills them. But institutional physicians prescribe it all the time because it drugs the people into a stupor which makes it easier for the staff. Apparently my father had wandered into the laundry room or something.

I told my mother all about it so she wrote them a letter forbidding them ever to give him antipsychotic drugs again. She handed over the same letter when we transferred him to a nursing home, but sure enough, a few weeks later she came to find him slumped in a chair, drooling and incoherent. They had ignored the letter, not to mention professional responsibility.

Via Roy Moynihan in BMJ (I think the masses will just get the first 100 words) I come upon the story of Fervid Trimble (yeah, funny name, she's English) an elderly woman living independently who entered a hospital with dizziness and diarrhea. Her daughter visited to find her delusional and stuporous. It seems they had decided she was depressed and given her an antidepressant, also a painkiller and various other drugs, including donezepil which is a useless medication heavily marketed for Alzheimer's disease. When the family asked that Fervid be taken off the drugs, she recovered completely.

Okay, so you have a plural of anecdote. For data, go to Garfinkle and Mangin who did a study in Israel. They found that community dwelling elders were taking, on average, 7.7 different medications. They also found that according to a protocol developed to assess overmedication in the elderly, 64 out of 70 were taking drugs they should not have been taking - a lot of drugs, 4.4 per patient. After they were stopped, in only 2% of cases was it decided to restart them. There were no adverse effects of stopping any of the drugs, and 88% of patients reported improvement in their overall health.

So why is this happening? For the answer, ask "Cui bono?" Somebody is making money.


kathy a. said...

interesting. my grandmother had dementia, broke her hip, the hip repair failed, etc. -- a cascade of problems. she also had periodic hallucinations.

during one of the hospitalizations, she was agitated and they put her on elavil. when we moved her from assisted care to a rest home, the home wanted to take her off the elavil because in their experience, that caused more problems than it helped. that really did help. (this was about 20 years ago.)

robin andrea said...

Maybe doctors should get written permission to drug elderly patients from spouses or children. And if they ignore requests not to give a particular drug, they should be sued for malpractice and have their license suspended. The over-drugging of the elderly seems criminal to me.

roger said...

somebody makes money on the drugs and someone else has to spend less on care, saving money for profits.

maybe what we need is actual legal custody of our elderly relatives so that when we say no mood drugs it is the same as the patient refusing meds.

my mother has been to emergency many times for pain. she demands pain meds. she gets pain meds and is loopy for days. sometimes quite rudely mean.

kathy a. said...

medical malpractice lawsuits aren't probably the answer. first, these don't have a lot of money damages in them, since the patients are elderly and not losing income -- so finding a lawyer might be a pain. second, all these years of "tort reform" have been designed to protect doctors, institutions, and pharmaceutical companies from lawsuits. third, lawuits take a long time.

what you want ideally is a medical power of attorney set up beforehand. more important is monitoring what's going on with the elder's care -- even without a power of attorney, caregivers will generally defer to "next of kin" with treatment decisions for incompetent relatives. complaints can be made to the medical licensing authorities, without a lawsuit -- and that's a good threat to use in case the doctor is uncooperative.

finally, it is best to settle on a doctor who will answer questions, keep family informed, and not just unilaterally decide to add medications or ignore problems. we fired the primary care physician for my mom (assigned at the hospital, and he carried over when she was in nursing care) because he would not respond to our inquiries, made orders over the phone without seeing our mother, and was just generally a snot. we substituted the medical director of her former nursing home, because he worked with us and did not try the "i'm god, just do what i say" brand of doctoring.

i wish i'd made a complaint to the medical board about dr. wonderful, but the whole situation was very traumatic at the time, and mom died a few weeks later.

Anonymous said...

I believe Goddamn the Pusher(man) was performed by Steppenwolf.
Great post though. We see the same being done to juveniles in the local correctional facility. These teens end up leaving the facility about 10-20 lbs. overweight after being on some of these drugs and their metobolic markers are all fucked up. They go home, stop taking the zombie pills and lose the weight. It's pretty amazing. I wonder how much of the obesity "epidemic" can be correlated as a side effect of the drastic uptick in psychotropic medications that list weight gain and "diabetes" as side effects.


kathy a. said...

roger, that's a tough one. my dad was not incompetent, and he resisted pain meds even when he was suffering a great deal from his cancer. that's not good, either. dosages are hard to manage with elders.

my grandmother complained of pain, and what she wanted was for me to bring 6-packs by the assisted care place. that one was easy: No. she was only on narcotic pain meds in post-surgical situations.

Cervantes said...

It's really amazing how ubiquitous these experiences are. Whenever I raise this issue everybody jumps up with "yeah, yeah, this is what happened to my [mother, father, uncle, brother, me . . . ]."

C. Corax said...

The same is done to mentally retarded people with behavioral issues, since their care was aggressively privatized by that a-hole who currently running for preznit. The private companies want the bodies for the money (=profit) but not the bother of caring for living beings, so they keep them in drugged stupors.

Anonymous said...

In the heat wave of 2003, remember, all those elderly patients who died in France? In the month of August? That was in a large part due to counting on ‘psych’ medication (which also affect body temp control, no doubt C will know more about that than me.) France is to be commended for airing the problem, publishing numbers, and seeking solutions, because there are other countries which I won’t name which had *more* deaths in the same circumstances, but hid it. Well OK, one was Italy.

Switzerland was all heigh-ho! we did better! (no excess deaths at all.) The explanations centered around, naturally, a) better med care as a whole, b) sociological explanations, going from closer family ties to not everyone pushing off in August to sip Pastis and wear Espadrilles (a holiday shoe) or traipsing off to the Maldives. -Vacs are staggered to ensure more than a skeleton staff at all times.-

In fact, psych meds for the elderly are severely controlled, limited. This does not mean that other factors played no role or were not dominant.

Skeptics quoted temperature stats, and the lack of AC in France. Forgetting that AC in Switzerland is officially forbidden (exceptions: shops and the food chain, hospitals, prisons and no doubt military computers..)

I have never figured out what is important here exactly, and probably never will, but I’d still be interested in some expert opinions about how over-drugging renders these elderly and sick folks incapable of handling changes in temp.

Of course in the US AC and temp control eliminates this factor somewhat so its possibly not the best place to find answers.


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