Screening madness & multiple meds in the elderly

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This week’s Journal of the American Medical Association published a paper, “Cancer Screening Among Patients With Advanced Cancer,” that concludes:

“A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.”

The authors write that this “adds to the mounting concern about overdiagnosis.”

A “Clinician’s Corner” column in the same journal, “Managing Medications in Clinically Complex Elders,” is another noteworthy read. Excerpt:

“Multiple medication use is common in older adults and may ameliorate symptoms, improve and extend quality of life, and occasionally cure disease. Unfortunately, multiple medication use is also a major risk factor for prescribing and adherence problems, adverse drug events, and other adverse health outcomes. Using the case of an older patient taking multiple medications, this article summarizes the evidence-based literature about improving medication use and withdrawing specific drugs and drug classes. It also describes a systematic approach for how health professionals can assess and improve medication regimens to benefit patients and their caregivers and families.”

L1389.jpg Last week in Amsterdam, I met Johanna Trimble of Vancouver, BVC, who has told “the story of how her mother-in-law’s health deteriorated when she was put on many medications but improved when her health professionals agreed with the family to try a drug holiday.” In fact, her poster about this story at the “Selling Sickness” conference won an award.

Johanna gave me a book, “A Bitter Pill: How the Medical System is Failing the Elderly,” by Dr. John Sloan. I haven’t read it yet. But she said she was delighted that it captured many of the issues she had confronted – some of the same issues touched on in this week’s JAMA.

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Michael Kirsch, M.D.

October 13, 2010 at 7:57 am

Not only are advanced cancer patients subjected to screening tests -medical sillyness – but many are also subjected to medical treatments for their disease that have risks and great expense,but marginal clinical benefit, if any.