Your Doc Doesn’t Know Which Drugs or Procedures to Give You

And it’s not his or her fault. According to the NY Times, doctors have to “guess” whether or not you should be taking a certain drug. And, if so, what your dosage should be. And what your likely side effects will be. They also don’t know which medical procedures that work fine on younger people will not work well for you. Ditto your response to different medical devices.

Why? Because drug companies, hospitals, and medical device manufacturers don’t bother to test their products on the elderly. Even — believe it or not — medicines, procedures, or devices particularly targeting seniors! And the National Institutes of Health won’t make them. 

“These findings are concerning because it means that doctors cannot be confident that clinical trial results apply to their older patients,” says Donna Zulman, M.D., M.S. Dr. Zulman is the lead author of a study by the Robert Wood Johnson Foundation.

In a great NY Times article, “The clinical trial is open. The elderly need not apply,” geriatrician Dr. Ken Covinsky calls it the exclusion of seniors from drug research “unacceptable.”

By 2030, adults over 65 will represent 25% of the U.S. population, and they will account for over 35% of the health care expenditures in the nation. Yet 20% of all clinical trials in the U.S. specifically exclude adults over a certain age in their designs.

And half of all studies use non-age methods of excluding the elderly — such as frailty, people with “limited life expectancy”(!), people with multiple disorders or disabilities, and people with mental impairment.

Why the new ruling won’t help much

The National Institutes of Health — starting in January — will require any grant applications submitted to them to “provide acceptable justification” for any age group they wish to omit from the study. But… many studies are privately funded and thus won’t have even this tiny justification to overcome.

And all applications for any grant from anyone can continue to exclude the elderly without spelling out an age limit — by limiting the clinical trial to exclude the frail, those with multiple disorders, and those with limited life expectancy.

Also, even in studies where the elderly were included, their results may not be published. Many studies include a few “token” elderly, then exclude them when they publish the results. So even when public money supports the research, the researchers can squelch how their medications/devices affected their few elderly test subjects — and there’s nothing we can do about it.

Why studies want to avoid seniors

Medical researchers have “good” reasons for wanting to exclude seniors from their research.

1. Because we’re more frail and because we react stronger to medicines, we’re more likely to show serious drug side effects. Drugs can look a lot safer (and be approved easier) if they show fewer side effects.
2. Because we’re often on other medications, including seniors makes for more complicated results. It’s much easier if the tested drug is the only one being taken. However… 70% of Americans are on one drug, and half are on two or more. So drug companies already deal with some of this complexity.

Heart disease medications

While 40% of those hospitalized with heart attacks are 75+, fully 1/2 of the clinical trials for heart disease medications had upper age limits that excluded those over 75 or 80. And even where there were no age limits, just 12% of the participants in those studies were over 75.

How bad a problem is this really?

We do know elderly bodies react differently to medications than do younger bodies. For example, as we age, our livers become less efficient at breaking down medicines, and our kidneys less efficient at excreting them. That means “normal” doses of some medications are more likely to cause side effects to seniors.

We also know elderly people are particularly susceptible to the side effects of opioid painkillers such as morphine and sleeping tablets such as diazepam. So doctors may prescribe lower doses and/or shorter periods of taking such drugs.

What we don’t know is whether these problems are important for specific drugs. For example, that heart drug you are taking… should you take less? We don’t know. Are there additional problems for the elderly for that drug — beyond what we know in general? We don’t know. Are multiple drug interactions worse for seniors? We don’t know.

How many seniors are dying because of uncovered problems? Nobody knows. And much, much worse — nobody is finding out.

Author bio
Marlene Jensen is a 71-year-old full-time marketing professor. Previously she was a VP at CBS and ABC and spent decades as an entrepreneur and pricing author/consultant. Sadly, none of these prepared her for the onslaught of marketers who now think her daily interests/needs consist solely of hearing aids, wheel chairs, adult diapers, medi-alert buttons, medications, and bath tubs you walk into.