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Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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An Over Medicated Nation!!!

May 16, 2009 - 13 comments
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your guide to optimal health

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Lee Kirksey

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medication errors

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medication

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Diabetes

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hypertension



A situation that happened in my practice this week motivated me to look up some information about American's use of prescription drugs for chronic disorders. The results of my search (below) are consistent with what everyone already knows. We are a heavily medicated country. There's a medication for every disorder. And the most frightening part of the whole equation is the rapidly increasing inclusion of children. Statistics show that up to 25% of insured children are on some medication (asthma, attention deficit and diabetes are the most common condition)

Medication Usage
51% of all insured Americans (including children) take at least one prescription drug
20% of insured Americans take three or more Rx drugs
75% of older adults take one or more Rx drugs
25% of older adults take five or more meds on a regular basis (28% of women and 22% of
men)

The fact that many older Americans are on long term medications is startling because of the know consequences and side affects of these medication. And unfortunately, the monitoring of these medications over times is sometimes inadequate

Older adults are seven times more likely to be hospitalized for an adverse drug event than
younger individuals.

Warfarin, insulin, and digoxin together account for over one-third of emergency department
visits for adverse drug events among older adults.—Budnitz DS, Pollock, DA, Weidenbach KN, et al. National
Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events. JAMA. 2006;296:1858-1866.

“About one in three older persons taking at least five medications will experience an adverse
drug event each year, and about two thirds of these patients will require medical attention.”—
Hanlon JT, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:945-8.

“If the findings of the present study are generalized to the population of all Medicare enrollees,
then more than 1,900,000 adverse drug events—more than a quarter of which are preventable—
occur each year among 38 million Medicare enrollees; furthermore, estimates based on our
study suggest that there are in excess of 180,000 life threatening or fatal adverse drug events
per year, of which more than 50% may be preventable.”—Gurwitz JH, Field TS, Harrold LR, et al. Incidence
and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289:1107-16.


The situation that prompted this blog was an elderly woman who recently had surgery. II saw her in the office to verify that she had healed her incision completely. As I was discharging her from my office, she asked if I could writer her a couple of refills on prescriptions. Her politely told her that I was not comfortable with that because I think, unless its an emergency, one physician should manage a patients medications. Well that lead to a discussion about how doctors are fleecing America

From Medco Drug Trends Report 2008, May 2008 (data from 2007)
Percent of prescriptions filled with brand name drugs declined from 45.9% in 2003 to 30.6% in
May 2008.—WSJ July 16, 2008 “Patients Curb Prescription Spending”New research reveals that one-third (34%) of seniors are taking medications prescribed by two or more physicians and that seven out of ten (72%) seniors reported taking medications that were first prescribed for them more than six months ago. Commissioned by the American Society of Health-System Pharmacists (ASHP), the survey of 275 Americans, age 65 and older, questioned seniors on their medication use as well as their knowledge and concerns about potentially harmful drug interactions.

Suffice to say that I encourage all of us who are on medications or who have family members on them to monitor the meds closely and ask for periodic reviews about how effective they are, what medications can be decreased or eliminated. We have to be our own advocates.

To learn more about Optimal Health, visit www.personalwellnesswheel.com and pick up Your Guide to Optimal Health: Creating Your Personal Wellness Wheel. Stay tuned for a teleseminar which myself and my co-author will be conducting on Medhelp.org.-your source for helpful medical information

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by PlateletGal, May 16, 2009
"And the most frightening part of the whole equation is the rapidly increasing inclusion of children."

Hi Dr. Kirksey,

I agree with everything you've written. Because of that, I have concerns about all of the pharamaceutical ads we seen while watching our favorite television shows. I think that many people believe that there are magic pills that will take away all of their ails and solve all of their problems, but we all know that it is not true. I'm also concerned that so many physicians are willing to prescribe so many pills, including anti-depressants to their patients, without evening suggesting counseling first ! Although I have a chronic illness (Chronic Fatigue Syndrome / myalgic encephalomyelitis), I am proud to say that I do everything and have always done everything to stay away from prescription medications. I do not take any narcotics and only take 2 prescriptions... both as needed. One of them is Relpex, for severe headaches that are triggered by weather or hormonal changes and I only take it the night before my visit with my massage therapist or the chiropractor. ; ^ )


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by Bon-Bon, May 16, 2009
Dr. Kirksey, thank you for your post.  

I agree that 'we are an over medicated nation'.  My husband and I were just talking about this same subject yesterday evening.

Years ago, an M.D. suggested I take a certain perscription medication.  When I asked about side affects, etc. she commented that 'when a patient decides to take a medication, the patient should realize that they very well may be trading one problem for another and that it's just a matter of asking yourself (before taking it) which problem would you be more comfortable living with?'.  

I believe there is truth in the comment she made in my case, I chose the temporary problem over the list of long-term and possible serious problems that could arise, be associated with or induced by the medication that was suggested.  Afterwards, both M.D. and  I realized that I definitaley made the right decision; but, ultimately it was my choice whether to take it or not.  I chose to make an informed decision based on my circumstances.

My husband and I are in our mid 40's.  We are medication-free as a result of asking ourselves that question before accepting a prescription.  

We are understanding and are very thankful of how helpful medication/s are when "needed"; but, all too often we feel medication/s are overly-prescribed in many cases.

Thank you.  We appreciate your time, expertise and information.
Blessings and Pleasant thoughts to you.
Bon-Bon



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by peggy64, May 16, 2009
Wow, you don't sound like a regular western medicine doc. You sound more alternative. Wish more docs felt the way you do.

It will be good for your patients if you follow this. The problem is the pharm companies won't like to hear you saying this because it will cut into their profits.

Do you know what I miss? When drs tried to get you well, instead of giving you pills, to have to get refilled month and month.
I realize not everyone can be healed, but lots of illnesses could be, but drs give them pills to keep them coming  back.

  I had a dr 20 years ago, write me a RX for paxil, whereas, if he had ran a thyroid profile, I would not have had the misery I have had to endure for the past year.  It made the pharm companies richer.

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by scinarie, May 16, 2009
Thanks for the post doc.  I totally agree about the over prescribing.  I am one of the lucky people who has a doctor who really pays attention to to what I am on and wants to hear from me when another doctor adds something.  She recently left her practice for one that allows her to see patients for as long as an hour if she needs to.  Her previous practice required that she see 37 patients per day.  Unfortunately, her responsible attitude has led her to a practice that Medicare and Medicaid will not cover.  Lucky me she is willing to keep me as a patient and accept what I can afford to pay her.

We are heading into a scary world.  Patients really need to be on top of their own care.  Having an accurate list of current meds and doses whenever we go to a health facility is vital.  Doctors simply aren't given the time to do all that they need to do for us in the 12 minutes or so that they are allowed to spend with each patient.

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by Barb135, May 16, 2009
I, like Peggy, had a doctor who wrote me a script for paxil because I was fatigued all the time and he insisted I was depressed, even though I tried to tell him I only felt bad because I was so tired; this same doctor accused me of being an alcoholic because my red blood cells were larger than normal - both of these symptoms (fatigue and large red blood cells) ultimately turned out to be pernicious anemia.  A shot of B-12 every 2 weeks goes a long way toward the "attitude change".  I was also later dx'd with hypothyroidism, and still later with Hashimoto's, which turned out to be another nightmare because my pcp insisted that ONLY synthroid would make me better.  How wrong could he have been............... I'm now on generic levothyroxine + cytomel ------ what a difference.  Yep - the pharmaceutical company got richer..........



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by bastet56, May 16, 2009
I totally agree with you Doctor. If you want proof of this over prescribing, go to the Anxiety Forum and you will read entry after entry of people who are on strong anti psychotic meds for anxiety. I don't think that anyone has informed them of the side effects that can last a lifetime. I am constantly amazed at the chemical cocktails that they receive.
Another thing that bothers me is the doctors that prescribe these meds at the behest of the pharmacutical company have no idea of the cost of these meds. I have Medicare part D which I am thankful for but after $2300 in prescriptions a year you are on your own. I was put on a name brand med that cost me out of pocket $1500 a month! I finally had to turn to a Canadian Pharmacy that sold the generic equivalent. When I told my doctor how much some of the meds she was prescribing, she was amazed. She had NO idea of their cost.

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by Melissa0116, May 16, 2009
Why is it that we cannot seem to find many Physicians that are like you.  I totally appreciate that you took the time to research this topic and point this out to all of us.  

I have a friend that I clean for on a weekly basis that has been undergoing chemo treatment for Breast Cancer (already gone and removed) and Ovarian Cancer (had hysterectomy and laporoscopy but still needs chemo for small seedlings found).  She has not put any type of medication of any kind in her body and rarely eats meat.  She takes supplements, juices, vitamins and has so much energy even though she has been going through chemo for 1 1/2 years now.  She does not take any hormones and does not have any type of hot flashing or hormonal imbalances.  The doctor and surgeon are baffled as to how she does it.  Well, my guess is that she takes care of herself and does not add chemicals to her body that would harm her.  I just wish that we could do this instead of taking all these prescriptions to supposedly help but that just causes other issues and side effects.  

The most disturbing thing is that we put our children on meds as soon as they do not perform or act a certain way in school or at home.  I have done so much research on ADD/ADHD and the funny thing is that researchers say that only 5 - 8 % of children are medicated for this disease.  I find that hard to believe.  There are at least 10 in my sons class that take meds for ADD/ADHD.  Why do we need to put our children on prescription meds?  Whatever happened to being a child.  They have to become adultlike as soon as they are old enough to talk and sometimes sooner.  We no longer stay at home with our children (that is due to a need for possesions and money in order to live in todays society) and spend time with them doing homework and just listening to them.  This country seems to want to make our children into Robots and focused on never letting a child make mistakes.  They seem to always be seeking more and more attention from all of us.  Maybe, we should focus on helping them by loving, listening, and giving them the right environment for them to be the best that they can be.  We are not all made to do great things.  Some do average things and some do not like to do much at all but that is O.K.  We were all made different for a reason and life gets very boring when things are methodical and rehearsed.  

I also see that we have too many different diseases and diagnosis.  Why can't there be a specific disease for many different symptoms instead of creating more problems than were originally their.  I understand that research needs to be done to find treatments for specific problems but it seems that we seem to create more and more diseases after a researcher discovered it in a lab.  Maybe we should find out why the lab seems to find more diseases or is it that they create more to make money.  I don't know but it is just disturbing to see the elderly taking 10 - 20 meds in order to live a longer life.  Does it really make their life longer?  I would probably think not.  I work with alot of elderly individuals that get very frustrated with having to remember to take all their meds and this just causes them to have anxiety.  Well, then we can just put them on anxiety medication.  And then when the anxiety meds cause some other problem their is another drug to take care of that issue.  It never ends.  

Again, thank you so much for your insight.  I just might have to think about coming to see you since you are only 1 1/2  hours away. LOL

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by Cherie762, May 17, 2009
Dr. thank you for the post, and my goodness, you are so right my teen son was Dx'd with anxiety and depression by 3 different doctors, it never fit his life. it did fit his symptoms, he was placed on Prozac and Xanax.lucky me and him, we found a really good phys. who after a few sessions realised my son was not depressed or overly full of anxiety , he was diagnosed with Vertigo, which made him nervous, thus mimicking anxiety...how easy he could have lead a life of wrong diagnosis and dependancy.

all the best,

Cherie

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by teko, May 17, 2009
So does this mean the small percentage of people who are not medicated, really are because of our drinking water? Can they filter all that out?

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by Tammy2009, May 17, 2009
Up until the last couple of months I never really used medication.  Once in a while I would get an infection that we sometimes got antibotics for.  Our family used so few prescriptions that we haven't had prescription coverage for 5 years.  

'However this year I found out that I have asthma and my quality of life has greatly improved with being on inhaled steroid.  I have tried only using albuterol when needed but it wasn't enough and I can't breathe for most of the day.  The steroids help immersely and I am greatful for that.  I also switched from using antihistamines for my allergies to allergy shots so hopefully they will work.  

Since I don't have coverage for prescriptions until next july (insurance is locked in for the year), I know first hand for the costs.  The first inhaler we tried was advair so a mix of two drugs and it was $120 every 10 days or so.  I also didn't think I need both a steroid and long acting broncodilator so we dropped the mixture and switched to pulmicort.  

I wish asthma was a condition that could go away but since it is triggered by cat dander and dust mites, likely isn't going anywhere.  The best I can do is to stay as healthy as I can and keep taking the meds that keep me breathing.  Just remember there are conditions that must be medication to control, but those people need to research and understand why they are on particular drugs and if others are necessary.

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by oleboney, May 18, 2009
That was a great article I agree with you on the over-medication. Many people just want the medicine, but other times, it is the doctor at fault. I am with medicine for epilepsy, asthma, and for my kidneys. My doctor said it was nessecary, and after trial and error, it has rung true. I see younger people that take more than me, and do the parents care? Nope, they just want the child to be calmed so they can handle them, and it is ridiculous.

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by dana007, May 19, 2009
Great write up.
As both a Registered Nurse, and someone who has Chronic Pain, I see first hand how doctors have overprescribed, although in Canada things are a bit different here. It perplexes me watching TV when I see all the commercials for the meds!! How ridiculous!!! I am also finding with obesity (and laziness) is a HUGE problem with today's society, and until the numbers get better and there is a better understanding of how eating well and exercise helps with the overall dynamic of how you live life, how is society to understand that they have the power to do otherwise than just take a pill to 'make it all better'??? We thrive on taking the easy way out. We are all in a rush these days because more people work, we have to drive and commute longer, we work overtime, we eat, less time for families.. the list keeps going on and on. We have to make the time to be educated and to try and make a difference, and a lot of people are willing to sacrifice themselves, even with the general knowledge out there that being obese is a bad thing-- how many people are taking that information and making a big change to show results?

You know what I mean? Just thinking about it makes me hungry though :) I lost 100 lbs, I'm proud, and it sure did my body a lot of good, yes sir!!

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by 64minx, Jul 13, 2009
Kudos to Dr. Kirksey!! After being on one version or another of anti-depressents for 12 years now, I still wonder if the diagnosing is correct. First diagnosis lead to me being on Zoloft and Wellbutrin with the intention of eliminating the latter within time. That all worked great and as you are probably aware, most people quit taking the meds once they start feeling better. That was very true for me but also because I don't like taking meds (not even aspirin, etc.) unless I feel it is absolutely necessary and secondly because of the stigma that goes with mental illness. It is a little hard to swallow that depression can't be controlled or managed by oneself. I went several years wondering why the littlest things would "set me off" and no matter what I did I just couldn't seem to control my temper. At the point of crying at a commercial showing a puppy trying to climb a set of stairs and fed up with the tightness and shortness of breath, I felt it was time to see a doctor. I was embarrassed and having trouble discussing my concerns and the doctor replied, "Are we a bit depressed?" I hated to hear that word but I was amazed she responded with what I already was questioning to be true. I wanted to feel better, so I welcomed the RXs. I was off the Wellbutrin 2 mos. later and chose to quit taking the Zoloft 6 mos. later. Low and behold 6 mos. after that I felt losey again. That cycle took place for several years before I accepted that I was destined to be on anti-depressents for the rest of my life. That doctor quit practicing so I had to find another and they (yes, there have been more than one) have lead me to wondering what really is MY problem and what IF anything is the right med for me. Each doctor seemed to want to just follow the pattern rather than listening to me and making their own diagnosis. I had questions & concerns and they just seemed to want to put me on some other version of an anti-depressent. Immune to the current one they would say. That all seemed logical so what the heck, they are the experts, right? I'm not so sure any more about anything any doctor has to say. I express concerns, they say, "I'll call in an RX." They don't bother to discuss what they are prescribing and why they are prescribing it. I can't tell you how many RXs I've picked up and after researching the drug on the internet I refuse to take it. I have shook my head so many times in disbelief. I do believe that something medically needs addressing but to get to the "what" is an issue in itself. Where in the world and how much is it going to cost me to find a doctor who actually gives a darn about my well being!!

The diagnosis summary thus far: asthma (but could be anxiety), depression/anxiety, migraines w/o pain (but could be mini strokes), allergies, hormonal depression and ADD. The latter was due to my inquiry after filling out a mini questionnaire which in turn was because I'm not convinced that depression is MY problem. Being aware of one's mind and body is great, self diagnosing is alright BUT a professional needs to call the shots. Again, where in the world is a doctor who really gives a darn instead of, "I'll call in an RX for you." I understand medicine isn't an exact science but why do doctors just resort to meds rather than running more tests or asking more questions so that they are certain of the diagnosis therefore prescribing the rights meds instead of using patients as guinea pigs to run the "trial and error" process. All meds come with side effects and some are worse than the condition they prescribe them for. Why do they not care if their diagnosis is accurate? Why do they not care about the well being of their patients? Could it all be that they chose the profession for the paycheck rather than the well being of people? If that's the case, I would have no problem with the government stepping in, but ONLY to regulate and decrease the pay therefore those who genuinely care will invest their time and money in schooling understanding that they may not recoop their investment monetarily but will be paid in something for more priceless...PRIDE, PRAISE and THANK YOUs.

As for me, I am now planning to look into having my hormone levels evaluated. My answer may just lie in an imbalance there...not an imbalance in my brain. And if so, the last 12 years has indeed been very profitable for the pharmacies and for all the wrong reasons! Beyond that, I'll continue to keep my ears wide open for referrals in hopes of finding that doctor who actually gives a darn about me rather than a systematic puppet, wealth chaser or pill pusher.

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