The Retirement Newsletter: Is this the start of the pill push?
Issue Number: -90 — Medicating old age — is there a pill for that?
Welcome
Welcome to issue number -90.
This week, I'm going to be looking at medicating our health as we age.
Health
I am not a medical doctor. I have a PhD in biochemistry. What follows is not medical advice — it is a thought piece on medication in old age.
A few weeks, I was speaking to my doctor about a long-term health issue that I have had for over 30 years: nothing serious or life-threatening, but something we regularly review because it impacts my quality of life.
And then the doctor said something that I was expecting:
“I think it is time we started medicating the condition.”
I replied:
“OK, with what?”
Being a biochemist, I keep an eye on the latest medical research for my condition, and I hadn’t seen any new research. I thought there must be a new wonder treatment out there that I didn’t know about.
The doctor then explained the idea. She said it was nothing to worry about. I just needed to take a pill once a week.
I asked how long and was told — FOR THE REST OF YOUR LIFE.
This shocked me. Was this the start of my medicated old age?
I asked the name of the drug and said I would think about it and get back to her.
Medication for the rest of my life
The idea that I may have to take a drug — a tablet — for the rest of my life shocked me.
If I had thought about it, I shouldn’t have been worried. I started taking medicines that I would take until I died 40 years ago. I have asthma. Without the daily use of my ‘preventer’ and the occasional puff on the ‘reliever’, I wouldn’t be here now.
About 15 years ago, I started taking a daily vitamin supplement on my doctor’s advice. I have taken that supplement every day.
I was already on ‘medicines for the rest of your life’.
I have friends who are my age who are already on two or three pills per day for the rest of their lives.
Daily medication seems to be part of the ageing process.
Medicating old age
We are living longer. I plan to live longer than my parents and have a better quality of old age. I am planning to remain active for longer — both physically and mentally. But I do worry about the increased use of medication. Is it improving and extending old age?
A paper published in the British Journal of Clinical Pharmacology (link) in 2021 carried out an analysis of data held in the World Health Organization Pharmacovigilance Database (VigiBase) to look for adverse drug reactions (ADR). In the study, the authors took the ADR reports available in VigiBase and removed all duplicates. This left them with 23,031,625 reports filed between 1 January 2010 and 31 December 2019. They then applied some search criteria (≥18 years old, sex, source of data, and death described as ‘sudden’ (excluding suicides)). This left 3,250,967 (14.11%) reports, of which 43,685 (1.34%) were defined as fatal. That is over 4,000 deaths per year due to ADR.
The research highlighted certain drugs as problematic and showed an increase in ADR in males over 65. All worrying stuff. However, the number of people experiencing ADR may seem high, but this is a self-reported dataset, so people taking the drugs and not having ADR will not be reported. Yet, it is still a concern, particularly as you age and pass your 65th birthday.
Over the years, I have watched various family members move into the late stages of old age, well past their 65th birthday. And as they age, the number of pills and potions they take increases. I’m surprised that some of my relatives don’t rattle. And there are three problems with this medicated old age.
1. Drug Specificity
First, a lot of drugs are not very specific. They are not well targeted — it’s a sledgehammer to crack a nut. The medications might have a very specific target, but many of these targets could spread around the body. That is, the same target occurs in many different cell types and organs. And the drug interacting with the targets in the different cells may cause unintended consequences.
For example, I used to teach about the use of anticholinergics in treating asthma. I told my students that there are three classes of the same target (receptor) within the lungs to which an anticholinergic could bind — M1, M2, and M3. These receptors are in different parts of the lung, but all bind to the same drug.
If the anticholinergics bind to one of the receptor classes, the patient won’t get asthma relief — it would worsen it. Whereas, if the drug binds to a different receptor class in a different part of the lung, it would provide relief from asthma. This effect comes down to the different classes of receptors (targets), which all bind the same drugs, being in different parts of the lung and having different functions. Targeting is important.
2. Drug Side Effects
Second, there is the issue of side effects. All drugs have side effects. Some side effects are very common, and some are rare. Some side effects can be beneficial, and some can be fatal, as shown in the paper (link).
The drug I have been asked to take was designed to treat one condition. But it was found that it also treated an unrelated condition. This was an unintended beneficial side effect. (By the way, the drug in question is a real ‘sledgehammer’. The drug interacts with mechanisms in the cell that are very common among the different cell types in the body. It isn’t very well targeted to the problem it is trying to solve.)
And this is the problem — as we age, we are prescribed more and more drugs, and some of the medicines we take interact and cause unintended side effects. We then take more drugs to deal with those side effects — a never-ending cycle.
3. Same drug, different patients, different outcomes
Third, pharmacogenetics. Nice word that.
Pharmacogenetics is a fancy way of saying that different people can react differently to the same drug because of their genetic makeup. It’s down to our DNA.
A few years ago, I did a home DNA ancestry test. I hoped to find I had some exotic past. I discovered that my ancestors came from a small area north of Birmingham. Nothing of note. No Viking, no Saxon, no wandering around Europe DNA. But, the test did show that I may interact with some types of drugs differently from the general population.
Summary
There now seems to be a pill for most things, but there are problems with medicating old age. Not all of us will respond to the drugs as the makers intended. There is the risk of adverse drug reactions, and we may take some medications to counter the side effect of others. Plus, as we age, our tolerance and handling of drugs may change.
I am not advocating avoiding taking medication in old age. The drugs work; they save lives. We live longer. But, we need to be cautious and make informed decisions about what we are taking and why.
If there is a bottom line here, it is that we should get regular reviews of our medication — type and dosage — from our pharmacist. We should not allow doctors to add on more and more drugs in an attempt to treat us.
Overmedication may be a problem.
I am not a medical doctor. I have a PhD in biochemistry. The above was not medical advice — it was a thought piece on medication in old age.
Useful links
Some useful links on medication and old age:
National Health Service (NHS), UK — Medicines information
National Health Service (NHS), UK — Live Well
National Health Service (NHS), UK — Mental Health
Center for Drug Evaluation and Research (CDER), USA — Drugs
Department of Health & Human Services (HHS), USA — Healthy Lifestyle
Department of Health & Human Services (HHS), USA — Mental Health
Department of Health & Human Services (HHS), USA — Ageing
Next week
Next week, in Issue -89, I will be looking at exercise in retirement — hobby or side-hustle? Can you turn it into a side-hustle?
Thanks
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Until next time,
Nick
PS, If you have something you would like to contribute to the newsletter — a story, advice, anything — please get in touch.