One reason older people are excluded is that the specific effect of a new drug can be "harder to tease out" when tested on people who are likely to have other medical conditions, says Michael Steinman, M.D., an associate professor at the University of California in San Francisco. "But also, from a drug company's perspective, it's advantageous to study a drug in younger, healthier people who are less likely to have side effects." The result, he adds, is that doctors are "handicapped" by not knowing "how well these drugs work in older and sicker people who most often need them."
Drug manufacturers spend billions of dollars persuading doctors to prescribe — and older patients to buy — the newest, most expensive medications. But studies show six out of seven "new" drugs are no more effective than "old" ones, and are riskier because they haven't been around long enough to have an extensive safety record.
Now, many doctors are becoming warier. Schiff is one who preaches what he calls "conservative prescribing." His very first suggestion to doctors is to "think beyond drugs" and discuss other effective methods of treatment — exercise, physical therapy and diet changes — that can improve many conditions, including high blood pressure and diabetes.
Still, it's easier for patients to pop a pill a day instead of dieting or exercising. It's also easier for physicians to prescribe pills, especially when people tend to want their money's worth when making an office visit. "The patient says: 'I took a day off work, I came down here, I want the antibiotic,' whether they need it or not," says Schiff.
It's hardly surprising if overworked doctors, seeing a patient for maybe 15 minutes or less, fail to recognize a symptom as linked to a drug the person is already taking — and not some new medical problem.
But, Zagaria says, people in her profession — independent consultant pharmacists trained to help older people manage all their medications — "automatically assume that a patient's new symptom could be related to medication unless you prove otherwise."