August 26, 2003 [Volume 4, Issue 18]
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In this issue of To Your Health:
Preying on the Elderly?
More than 90% of people over age 65 may use at least one medication each
week, and up to 40% may use five or more drugs per week. With so many
seniors taking medications (or combinations of multiple medications),
errors in prescription or administration are inevitable. Although the
majority of these medication errors do not cause injury, extensive drug
use by the elderly generates a significant 
number
of deadly reactions or side-effects.
Based on data gathered over a one-year period from almost 30,000 Medicare patients ages 65 or older, potential adverse drug events (ADEs) were compiled from multiple sources: health-care provider reports; hospital discharge summaries; emergency department notes; administrative incident reports; etc. Adverse reactions occurring in the hospital setting were not evaluated in this study from the Journal of the American Medical Association.
The overall rate of adverse drug events was approximately 50 cases per 1,000 patients over one year; over a fourth of the ADEs were considered preventable. More than one-third of the reactions were deemed fatal, serious or life-threatening (an even higher percentage of these most-dangerous events - 42% - were preventable). Errors most often occurred in the prescribing or monitoring stages. Cardiovascular medications and antibiotics were not only the most-prescribed medication classes, but also the most likely to be linked to an ADE.
If these findings are generalized to all Medicare patients, nearly 2 million ADEs - a half-million of which are preventable and 180,000 of which are fatal or life-threatening - may be suffered annually in the U.S. Complicated medication regimens can confuse seniors and the family members who assist them. Also, rushed appointments with busy doctors can lead to mistakes in prescription and communication. Be absolutely certain that each and every medication you take is considered safe, especially when combined with other prescriptions. Taking the fewest drugs possible is the best way to avoid an accidental reaction.
Reference: Gurwitz JH, Field TS, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. Journal of the American Medical Association 2003:289(9), pp. 1107-1116.
More senior health information can be found at www.chiroweb.com/find/tellmeabout/senior.html.
Prone to Problems
Reports of sudden infant death syndrome (SIDS) in the U.S. have declined dramatically since measures in the 1994 National Institute of Child and Health and Human Development-sponsored "Back to Sleep" campaign convinced most parents to place their babies on their backs for sleeping. Persistent concerns of possible dangers (e.g., choking on vomit) have prevented some parents from adopting recommendations to place their infant on its back for sleeping, however; one in 10 infants is still placed on its stomach, or in a prone position, to sleep. Are these fears realistic, or merely myths?
Information on almost 4,000 infants that always were placed in the same position for sleep (back, front or side) was analyzed in this study from the Archives of Pediatrics and Adolescent Medicine. At one, three and six months of age, researchers asked the mother about the presence of symptoms like coughing, fever, trouble breathing or sleeping, and vomiting.
Infants placed to sleep on their backs were not at an increased risk for health problems. In fact, they were less likely to have fevers, stuffy noses or ear infections than infants placed to sleep on their stomachs or sides, and reportedly slept better. No back-sleepers were noted to choke on their vomit. Also, no symptoms were significantly more common in infants sleeping on their backs or sides than in infants sleeping prone.
Not only does placing your baby to sleep on his or her back reduce the chances for SIDS, it also appears to reduce the risk for other health problems found in infants. Research is more reliable than hearsay advice; be sure to always place your baby on his or her back at naptime.
Reference: Hunt CE, Lesko SM, et al. Infant sleep position and associated health outcomes. Archives of Pediatrics and Adolescent Medicine 2003:157(5), pp. 469-474.
For more information on children's health, visit www.chiroweb.com/find/archives/pediatrics.
Unbalanced Reporting
Patients often name the media, along with doctors and pharmacists, as a primary source of information about new prescription medications. One of the primary goals of news media is to protect the public good by providing fair, balanced and accurate information. Minimally, news reports on new drugs should list both the harms and benefits, along with their role in treating a condition.
In Canada, where more money is collectively spent on prescription drugs than doctor visits, a study in the Canadian Medical Association Journal evaluated newspaper articles in 2000 reporting on new drug benefits and risks, and other aspects related to fair and balanced reporting. Researchers looked at news coverage of five prescription drugs launched between 1996 and 2001 that were prominently named in the media (Lipitor, Celebrex, Tamiflu, Aricept and Evista). Articles that named at least one benefit or harm for any of these medications in any of Canada's 24 largest daily newspapers were considered.
Almost 200 newspaper articles reported at least one benefit or harm of one of these five drugs in 2000. Every article mentioned a minimum of one benefit, but over two-thirds did not mention any possible side-effects or risks from taking these drugs. In fact, drug benefits were five times more likely to be mentioned in articles than harmful side-effects. And merely 4% of the articles mentioned contraindications to drugs, or significant reasons not to take them - information needed before safely deciding to take a medication.
This study highlights the concern that media reports on new drugs may be incomplete and present an unbalanced view of medications, making people decide they need a particular drug for their condition based on minimal information. Although this study was conducted in Canada, for comparison, a similar study conducted in the U.S. showed that over half of media reports mentioning drug benefits listed no potential harmful side-effects.
Don't formulate opinions about the value of a new medication based on the media - only your physician is qualified to determine which prescription drugs are safe and effective. Your chiropractor is also an important source of information, particularly when it comes to proposing nonpharmaceutical options for dealing with your condition.
Reference: Cassels A, Hughes MA, et al. Drugs in the news: An analysis of Canadian newspaper coverage of new prescription drugs. Canadian Medical Association Journal 2003:168(9), pp. 1133-1137.
To read about the many risks associated with prescription and over-the-counter drugs, go to www.chiroweb.com/find/archives/general/drugs
More Good News for Wine Drinkers
If you consume alcohol on a regular basis, here is some information you'll want to know. Past research has shown a link between alcohol intake and colorectal cancer. According to a recent study in the journal Gut, however, that risk diminishes when the alcohol consumed is wine, as opposed to beer and other spirits.
Researchers in Denmark conducted a study of approximately 30,000 men and women between the ages of 23 and 95 over a period of nearly 15 years. The amount and types of alcohol consumed were determined at the beginning of the study period, and cases of colon and rectal cancer recorded in the Danish Cancer Registry were used to determine possible relationships to drinking alcohol.
Those who consumed over 14 drinks per week in the form of beer and spirits only were over three times more likely to develop rectal cancer than nondrinkers. On the other hand, people who drank the same amount of alcohol, but reporting one-third of their drinks to be wine, were less than twice as likely to develop this form of cancer. The researchers also found that people who drank excessively (more than 41 alcoholic beverages per week) had twice the risk of developing rectal cancer than nondrinkers, regardless of the type of alcohol drank.
This study offers two important points to alcohol drinkers: First, drinking any alcohol appears to increase a person's risk for rectal cancer. The more you drink, the higher your risk for cancer. Second, if you do drink, you may want to consider sticking to wine. The powerful antioxidants in wine appear to blunt some of the harmful effects of alcohol.
Reference: Pedersen A, Johansen C, Grønbaek M. Relations between amount and type of alcohol and colon and rectal cancer in a Danish population based cohort study. Gut 2003:52(6), pp. 861-867.
For more information on nutrition, go to www.chiroweb.com/find/archives/nutrition.
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