WSJ Profiles ‘Renegade’ Doctor Who Prescribes Fewer Pills to Elderly Patients
The Wall Street Journal today profiles an unlikely "renegade," Dr. David Morris, who did "something daring" at the New York-based Hebrew Home for the Aged -- he "wean[ed] residents in his care off many of their medications," most often those for diabetes, hypertension, high cholesterol and depression. Most of the time, Morris ceased the medications because he believed they were "doing nothing at all for his patients," but in other instances, he was concerned that the medications "might be dangerous." The average American age 65 or older takes about six medications, and nursing home residents take about eight medications, the Journal reports. Morris halted diabetes medications for 10 patients because he determined that the medication-induced weight gain was a "greater risk than letting blood-sugar levels rise a bit." In addition, he took 25 patients off of psychotropic drugs. Although many of his patients benefitted from fewer drugs, Morris' actions have "proved divisive" at the nursing home. Many residents and family members have "vehemently objected to his decisions," none of his fellow doctors have followed his lead and the home's medical chief has called his actions "overzealous." Hebrew Home Medical chief Suzy Abraham said that although she "praises" Morris' efforts, in a number of instances "he was cutting medications too drastically, two and three medications at a time." But Daniel Reingold, who runs the Hebrew Home, supports Morris, stating that the elderly are "routinely 'overmedicated.'" Reingold's support for Morris is partly financially related -- he has watched the home's pharmacy expenses "soa[r] in the 1990s." Last year, expenses reached $2 million, up from about $1.5 million five years earlier. But as he "fought to hold down costs," Reingold "came to believe that fewer drugs might even improve patient care." Reingold intends to hire a staff pharmacist whose "primary job" will be to "help physicians zero in on unnecessary prescribing," the Journal reports.
Morris' case "spotlights a dilemma facing the entire country" -- although "breakthroug[h]" drugs have improved Americans' quality of life and extended their longevity, the "very same pills can also cause surprising harm." The CDC determined in 1999 that more than 600,000 hospital admissions and 700,000 emergency room visits were the result of correctly administered medications that produced adverse side effects "and even death." The elderly, because they take the most medications, have the greatest risk of such drug events, the Journal reports. Older people metabolize drugs less quickly than younger people and should take lower doses or "avoid some drugs altogether," the Journal reports. For its part, the drug industry "acknowledges that pill overload is a problem for older Americans but downplays its direct responsibility." Industry officials maintain that physicians should be responsible for managing patients' medicines. But the Journal points out that many people see "multiple doctors, with no single physician monitoring the overall medication regimen." Another problem is that doctors are "often flying blind" when it comes to prescribing medications for the elderly because there is a dearth of information about doses and side effects for the elderly, the Journal reports. However, Brigham and Women's Hospital researcher Jerry Avorn said that "systematically reviewing patients' medications 'may be one of the most important medical interventions [doctors] can do'" (Orey, Wall Street Journal, 6/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.