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When Medicine Does More Harm Than Good

About 20 percent of older Americans with chronic conditions are taking medicines that work against each other, according to a new study. In other words, the medication being used to treat one condition can make another condition worse.

The problem affects millions of Americans, since three out of four older adults have multiple chronic conditions.

Researchers from Oregon State University and Yale School of Medicine identified some of the most common “competing” chronic conditions. They included hypertension and osteoarthritis; hypertension and diabetes; hypertension and COPD; diabetes and coronary artery disease; and hypertension and depression.

This kind of conflict, experts say, has its roots in the practice of treating one condition at a time; there isn’t much information to guide practitioners on how to identify and evaluate different options.

Specifically, the study found that 22.6 percent of participants took medicines that could worsen another of their condition. The research was published in PLOS One.

Among those patients, only 16 percent had their drug treatments changed as a result of finding out about the competing conditions. Practitioners still prescribed competing drugs the rest of the time.

“Many physicians are aware of these concerns, but there isn’t much information available on what to do about it,” said David Lee, an assistant professor in the Oregon State University/Oregon Health & Science University College of Pharmacy.  “As a result, right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse.”

The researchers cited the example of patients who have both coronary heart disease and chronic obstructive pulmonary disease, or COPD. Beta blockers are often prescribed to treat the heart disease, but they can also cause airway resistance that worsens the COPD.

“There are several types of beta blocker that don’t cause this negative interaction, but many of the other types are still prescribed anyway,” Lee said. “It’s this type of information that would be of value in addressing these issues if it were more widely known and used.”

 “More than 9 million older adults in the U.S. are being prescribed medications that may be causing them more harm than benefit,” said Jonathan Lorgunpai, a medical student at the Yale School of Medicine and co-author of the study. “Not only is this potentially harmful for individual patients, it is also very wasteful for our health care system.”

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