“I have cured more disease by stopping medications than starting them…”

Polypharmacy is a difficult problem for many physicians who treat older patients, but there are steps they can take to cut down on their patients’ medications, Amit Shah, MD, said here at the American College of Physicians annual meeting.

“I do a lot of medical student and resident teaching, and whenever I teach this topic, I like to say, ‘As a geriatrician, I have cured more disease by stopping medications than starting them,'” said Shah, who is at the Mayo Clinic in Scottsdale, Ariz. “It’s a bit of an overstatement but it gets people’s attention” because they never thought about fixing problems by taking medications away rather than adding things on.”

Shah added that he is not a “nihilist,” and that he likes the fact that physicians have drugs they can offer patients. In addition, he noted that “Underprescribing can be just as much a problem as overprescribing.”

However, there are reasons why some patients get prescribed more drugs than they may actually need, Shah said. One is “prescribing inertia” — the patient is already taking the drug, so when it comes up for a refill, the doctor automatically refills it. Electronic medical records make it amazingly easy to approve a refill, he added.

As an attending physician, “I once almost killed [an 86-year-old] patient who didn’t get killed by their saddle pulmonary embolism…he had been on four blood pressure medicines prior to admission,” Shah said. At discharge from the intensive care unit, the intern just hit “continue” on the computer four times, and kept all four of the medications going, even though “the patient’s heart was not the same heart it was prior to his PE…His saddle PE didn’t kill him but me and my intern almost did.”

“If the intern had to write out four new prescriptions like we did once upon a time, he wouldn’t have started the patient on four new blood pressure medications at discharge…This was a systems issue,” Shah said.

Other reasons polypharmacy occur include the assumption that there must be a thoughtful provider behind each prescription, “not wanting to step on the toes” of the original prescribing provider, and patients and providers not wanting to “rock the boat.”

RTFA. There’s not only more of the same – there are 10 steps to unwinding an excess of prescriptions in a healthful manner. If required.

Dr, Shah ends, simply: “It’s really fun when you unwind six to seven medications in your patients, which I’ve done, and they feel better.”

E-cigarette poisonings reach epidemic levels in young children

Electronic cigarettes have sickened rising numbers of young children, a study of U.S. poison center calls has found. Most cases involve swallowing liquid nicotine.

While most kids weren’t seriously harmed, one child died and several had severe complications including comas and seizures.

This is an epidemic by any definition,” said lead author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital…

The researchers say the results highlight a need for better parent awareness about the importance of keeping the devices out of sight and reach of young kids. They also recommend stricter regulation and applauded long-awaited restrictions the U.S. Food and Drug Administration issued…

The study examined poison center calls about exposure to nicotine and tobacco products among children under age 6 from January 2012 through April 2015. The most worrisome findings involved e-cigarettes — battery-powered devices that turn nicotine into an inhalable vapor. Some feature colorful packaging and flavored nicotine that can attract young children.

I find it hard to believe that parents are ignorant of the dangers presented by these materials. Sure, they bullshit themselves to keep up their habit/addiction. Still, they must realize the threat to young children.

RTFA for details on the study. I chalk this one up to stupid.