DRUG BUST by Alan Cassels
I-ro-ny [ahy-ruh-nee] – noun, plural-nies: the use of words to convey a meaning that is the opposite of its literal meaning.[From dictionary.com]
We’ve all heard a lot about the “greying of the population” and how the growing numbers of baby boomers entering retirement are going to make public healthcare around the world absolutely unsustainable.
We are told perennial stories of how old people hog hospital beds and fill up expensive “assisted living” facilities – where a growing number of them require more individualized care, more medical procedures and a lot more drugs, all of which cost a ton of money.
Experts and other commentators point to the expensive care of the elderly as the likely straw that is going to break Canada’s camel-backed socialist medical system. The usual solutions put forth to deal with the coming demographic tsunami typically include:
1. Putting more private money into healthcare: nope, that’s a loser of a solution as everyone knows private health care is more expensive.
2. Raising taxes: also a difficult solution – look at the recent mudslinging over the harmonized sales tax in BC and Ontario and tell me a better way to effectively rouse the masses to insurrection.
3. Providing less healthcare: that’s a tough struggle too because every dollar saved on healthcare is either someone’s profits or someone’s income and who wants to take the blame for removing profits from those who depend on performing surgeries, selling drugs and treating people?
So while politicians and health policy makers are wringing their hands, searching frantically for solutions to a healthcare system groaning under the weight of the exploding numbers of elderly people, let me propose a modest solution: let’s increase prescription rates for seniors. That’s right, contrary to those nattering pharmaceutical nihilists, we must enact policies to get more and more pharmaceuticals to even more seniors if we want to make healthcare more sustainable.
We already know that pharmaceutical-induced deaths among the elderly are enormously helpful in freeing up more beds for other patients, reducing the workload of healthcare workers and the need for further expensive medical procedures. That’s why polypharmacy – the practice of taking multiple prescriptions – is the right solution to save our health system money.
We also know that taking many different prescriptions every day is a practice that is likely shortening the lives of many people doing it so a simple cost-saving solution is to get more patients to do more of it.
I have found it somewhat futile to be constantly promoting rational and sensible pharmaceutical use. Teaching doctors to be rational prescribers and educating patients to be sensible prescription drug users go against the grain of established medical practices and against the best energies of the pharmaceutical marketing machinery. Canadian seniors already take an obscene amount of drugs so let’s not fight it. Let’s go with the flow on this one.
A study released last month by the Canadian Institute for Health Information confirmed this in saying almost two-thirds of Canadian seniors (people 65 and older) take, on average, five or more prescription drugs on an ongoing basis. One in five seniors is taking 10 or more drugs and one in 10 are taking 10 or more. About six percent of Canadian seniors – over 250,000 people in Canada – are firm testimony to the slogan “better living through chemistry” as they swallow 15 or more prescription medications per day.
When I ask the experts for data showing that this kind of multiple drug use is safe and effective, they stammer, get red-faced, ask me to close the door and then admit that most drugs are never tested in combination with other drugs. We really have no idea what is happening in the innards of Mrs. McGillicutty when she slugs back a cholesterol-lowering drug, two blood pressure pills, an anti-anxiety medication, an aspirin for stroke prevention and a drug for her arthritis everyday. They don’t usually test drugs with other drugs. And the hospital pharmacist I once challenged on the practice of giving my mother a fistful of drugs (she was only taking one when she entered the hospital) answered, “But that’s the way we do things.”
How can you challenge that reasoning? Why give seniors lots of drugs? “Because it’s the way we do things” seems to be the prevailing logic. So let’s run with that.
It’s not just the sheer volume of drugs in the elderly that is helping to reduce the numbers of old people; it is the types of drugs they are taking. There have been numerous recent examples, such as the Cox-2 inhibitors like Celebrex, Bextra and Vioxx, which we know increase cardiovascular risks, heart attacks and strokes. The warnings on the labels say so. Seniors are the major consumers of arthritis drugs so is it possible that their consumption of the more unsafe ones is helping sustain our health system by booking them earlier appointments at the pearly gates? If the drug companies had their way, seniors would also still be taking Vioxx and Bextra in large numbers, but since the body count got too high on those two drugs, and the litigators got involved, the companies were forced to remove these from the market
There are many more rich examples of drugs used in the elderly that are likely increasing the death rate of seniors, instead of decreasing it, but none worse than the antipsychotic drugs, such as Seroquel (quetiapine), Zyprexa (olanzapine), Risperidal (risperidone) and Geodon (ziprasidone). These unusually toxic treatments are meant for people with schizophrenia or bipolar disorder, but that doesn’t stop doctors from prescribing them to adults with a range of mental illnesses and to unruly and anxious kids as well as grumpy seniors. Giving antipsychotics to seniors housed in long-term care facilities has become, in my mind at least, the most spectacular example of cost-efficient, cull-the-seniors prescribing in existence.
One study found that if you are senior in Ontario admitted to long-term care, you have a 20 to 40 percent chance of being prescribed an antipsychotic. That’s astounding considering there is a Health Canada warning that says the antipsychotics are strictly not to be used in the elderly who are suffering from dementia (which might be one of the main reasons people are put into care homes).
My hunch is that antipsychotic drugs are being widely used to calm down elderly people a little grumpy about life in seniors’ homes, despite the risk of side effects including sedation, falls and hip fractures. One of the most worrisome adverse effects is involuntary muscle movement – tics and spasms known as tardive dyskinesia – which can be irreversible. An important clinical trial of Seroquel and four other antipsychotics found that all five drugs caused tardive dyskinesia (affecting about 13 percent of the patients during 18 months of treatment).
In one study, elderly people in the community who were prescribed an antipsychotic drug were between 3.2 times and 3.8 times more likely to develop any serious event, such as a hospital admission or death, within 30 days, compared to those who received no antipsychotic therapy.
If antipsychotic drugs don’t actually kill or maim patients, they could increase their risk of developing another disease, like diabetes. The label on the drug Seroquel (quetiapine) in Canada says, “Increases in blood glucose (sugar) and hyperglycaemia (high blood sugar) have been observed. Also, occasional cases of diabetes have been reported.” The US medication guide for Seroquel says a similar thing: “High blood sugar (hyperglycemia): Increases in blood sugar can happen in some people who take Seroquel. Extremely high blood sugar can lead to coma or death.” It’s been known for some time that antipsychotics disrupt the body’s regulation of blood sugar, often leading to weight gain and diabetes and about 17 percent of Seroquel patients in one study experienced clinically significant weight gain.
I’m not the only one who believes that the risks of developing diabetes with antipsychotic drugs have been downplayed or hidden for a long time. On that very issue, there are about a zillion lawyers in the US currently suing drug companies like AstraZeneca, makers of Seroquel. And the data on the diabetes issue aren’t pretty. Quarter Watch, an arm of the Institute for Safe Medication Practices in the US (www.ismp.org) examines adverse drug reports made to the US FDA. In its most recent report, it found that Seroquel was the suspect drug in more possible cases of diabetes than all other drugs combined.
Not only is Seroquel a blockbuster drug and the 20th most lucrative branded drug in the US; it is the leading product sold in its class, holding 31 percent of the antipsychotic market. Quarter Watch’s new safety data related to Seroquel bode well for the expansion of the use of this drug in almost everyone. As of December 2009, the drug was approved in the US as an “add-on” treatment for major depression that will no doubt massively increase the numbers of people who get it.
Back to my premise: all indicators point in the direction of more and more prescription drug- induced death. Let’s face it; a prescribing pen is an extremely effective way to cull seniors at any age, and thus getting that pen writing even more prescriptions is likely to be an important and effective solution to our healthcare funding crisis.
More Seroquel. More Celebrex. More drugs for more and more seniors.
Let’s not be influenced by the naysayers who are alarmed at the growing amounts of drugs swallowed every day by seniors. While it sounds heartless, more prescription drugs swallowed by more elderly people is what the doctor must order to keep our healthcare system sustainable.
Alan Cassels is a modern-day Jonathan Swift wannabe, as well as a drug policy researcher at the University of Victoria and the author of The ABCs of Disease Mongering. Read his other writings at www.alancassels.com