A prior post discussed the importance of taking medication as prescribed, focusing on medications that were intended to prevent things like strokes, heart attacks and fractured hips. There is another side to the coin.

            Doctors are increasingly aware of the problem of “polypharmacy,” taking a lot of pills. Almost 60% of all Americans take at least one prescription medicine, and a third of Americans over 65 take five or more medications daily. Add to these various supplements and over-the-counter (OTC) pills, and that can add up to quite a handful.

            At times, this may be appropriate and beneficial. If you have diabetes, hypertension and congestive heart failure, most of your pills may be needed. However, in many cases pills have been added by one doctor unaware of what another doctor prescribed.

            Your primary-care doctor (if you are fortunate enough to have one) may not even be aware of everything you are taking. Many medications interact in ways that may be harmful. Some may have been intended only for short-term use but were never stopped. Some may have been appropriate when you were younger but have more side effects as you age.

            Some specifics: Many drugs to treat bladder problems cause dry mouth in everyone but also constipation, confusion and falls in the elderly. Young patients with diabetes with good home support benefit from having their blood sugar tightly controlled; it prevents later eye, kidney and vascular problems. Older patients benefit less and are much more at risk of low blood sugar (hypoglycemia), which can be a serious threat, even fatal, if they are over-medicated.

            Some patients whose blood pressure has been well-controlled can lower or stop their medications and maintain good pressure for extended periods or indefinitely.

            Anti-anxiety medications and many sleeping pills have been repeatedly linked to falls in older patients who take them. Digoxin has been used for a century to treat heart failure but more recently has been found to increase death rates in people who take just a bit too much.

            What can you do? First, be sure to carry with you a list of every pill you are taking. This may be life-saving should you end up in an emergency department, but it should also be shown to any doctor you see. Periodically it is useful to ask your primary-care doctor to review what each of the pills is for, and to ask whether there are any that might be safely stopped.

            I would always ask my patients once a year to make a “brown bag visit,” bringing in every pill they had at home, and we would often be able to cull many that were duplicating each other. It was amazing to find that people were often taking the same medication twice, because the pills in the different bottles looked different because of different manufacturers and may have even had different names – one branded, one generic. It may be appropriate to ask if lifestyle changes could take the place of some of your pills. If you are willing to put in the effort, this is often possible.

            The same review may be able to identify expensive pills that have an equally good and cheaper alternative.

            Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.

What Does The Doctor Say?

By Dr. Ed Hoffer

            Election time is upon us in the Tri-Town area, and nomination papers are out. So far it appears there has been no great stampede to run for office. But there is still time.

            My first foray into public office was on an appointed committee. I was recruited to join a local Bylaw Study Committee. The person who saw my vast potential went on to be a Massachusetts State Representative and later join the U.S. State Department as member of the George W. Bush administration. He became an expert on foreign affairs, an author and a Distinguished Professor of International Development at Texas A&M University. I mention this only to point out that even smart people can make mistakes.

            Anyway, a Bylaw Study Committee reviews, analyzes and proposes new laws and decides if they should be presented to a Town Meeting for consideration by the public. During my time, we considered many important issues like whether to allow wood piles on residential property, or if yard sales should be banned on weekends.

            Membership on the committee proved that a little power can be a dangerous thing.

            My tenure on that committee taught me one thing, to love meetings so much that I began to attend all Finance Committee meetings, Select Board meetings and School Committee meetings. The local newspaper called me the town’s “official civic auditor.”

            I was also on the Police/Fire Study Committee, the Dispatcher Review Committee, the Town Hall Restoration Study Committee and one or two others I have forgotten.

            After over 10 years of that insanity, I ran for an elected spot on the School Committee. On my second try I won. During my six years as a member in good standing among the ruling class, I learned many things.

            Being on the highest rated local cable TV show every week puts your opinions out there for the world to see. I learned that your phone never stops ringing and that few people call to express warm thoughts about those opinions.

            Contract negotiations were the most fun. As a teacher myself at the time, it was a bit awkward to be on the adversarial side of the table. The teachers’ union lawyer happened to also represent me as the lawyer for the faculty at the college where I was teaching.

            During one session, a physical education teacher on their side who had big muscles (did I mention she was a rugby player in college) and was nicknamed “Killa” by the students, threw a chair across the table. Thankfully, quick reflexes avoided injuries, though the chair was destroyed.

            Another time, having to walk through a gauntlet of massive Teamsters, whom the union had enlisted for support, was, admittedly, intimidating.

            After every meeting, which sometimes went on past my bedtime, there would be a reporter with a tape recorder asking for a quote. Once I woke up to my voice on the clock radio. None of what I had said was what I heard! They had edited my words to suit their narrative. I got a retraction, which was broadcast at 3:00 pm when nobody was listening. I never responded to a reporter’s questions after that.

            There were good times. The superintendent’s Christmas party was always a blast. All expenses paid trips to resorts for conventions were always enjoyable. The annual trip to the State House to lobby our representatives and feast on a giant buffet of delicious food prepared by vocational schools was always fattening … er, fulfilling. So is public service. Go ahead, dive in.

            You wouldn’t want to miss all the fun.

            Editor’s note: Mattapoisett resident Dick Morgado is an artist and retired newspaper columnist whose musings are, after some years, back in The Wanderer under the subtitle “Thoughts on ….” Morgado’s opinions have also appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado