Less is more or Less

As we grow older and face our certain, inevitable mortality, it is understandable if we attempt to incorporate every identifiable intervention that might mitigate our chances of death. Or put another way, increase our chances of life.


The life-sustaining promise associated with ingesting drugs has become a huge part of being a senior citizen in America. Actually this is true for most of America, but particularly for the seniors. The mantra of “take your pills daily or risk dreadful consequences” has its positives and negatives. Keep in mind these are powerful drugs, not benign, cutely shaped candies. Each in its own right has a powerful affect on the body. Add drug upon drug, upon drug and you have a potentially lethal mix of conflicting agents. Too many of our Medicare Part-D eligible seniors have built up a laundry list of drugs that is robbing them of the precious vestiges of health.

It is easy to eventually progress to consuming up to 15-20 different drugs because it costs them “nothing” out of pocket. Their co-payments are close to zilch, nada, nothing. Since these drugs are ostensibly “free”, many Seniors end-up with a bag full of prescription drugs and maybe or maybe not take all or some of them. In any case, the need for a qualified drug screener is lacking at the point of delivery. The pharmacist is in an ethical and monetary quandary. Professionally, he is charged with making sure the drugs first and foremost do no physical or mental harm, secondarily the pharmacist is there to make sure a patients’ drug therapy is at its most efficient. In other words, the least amount of drugs to elicit the healthiest patient-state possible. This may at times call on the pharmacist not to fill one or several prescriptions as presented by the patient/customer. This of course means, s/he is in fact turning away money, since a filled prescription means money in the cash register (or at least a bill to the insurance company). The pharmacist in a position not unlike the physician/medical center owner who increases his profits by “churning” his patients/customers for more tests, procedures and follow-ups, whether they need them or not. The more “things” you do, the more money you get paid. For the pharmacists, the more prescriptions you fill, the more money you make. Currently, our drug delivery system is not set up to use the pharmacists’ expertise to professionally manage patient’s drug therapy. We simply sell the drugs behind the fasade of being the gatekeeper drug expert. We honestly would rather be concerned foremost with effectively managing your total drug consumption. The reality is far removed from theory. Our prevailing business environment simply does not permit such actions on a consistent basis. Sadly, the "drug expert" has been reduced to an overpaid cashier in one retail drug chain. I challenge all pharmacists to regain their professional calling; re-assert their use to the American people as a source of tremendous savings. Now is the time!! Take care of our grandmothers and grandfathers. Not simply as robotic technicians in a drug delivery system, rather as drug therapy managers and perveyors of healthy outcomes. But of course, the devil is in the details.

Part-D The not so hidden costs

We (Americans) are a very "giving" society. We have much, therefore we can afford to give much. We cheer the underdog, who valiantly tries to surmount, insurmountable obstacles. We feel good as we help the poor with gifts, donations, new this or new that. We feel fulfilled because we have given what appears to be much needed assistance to a less fortunate human. So too was the intent of Medicare Part-D, that is to help eligible senior citizens afford life-sustaining or life-lengthening drugs when they might otherwise go without these drugs. On board the train of good intent, and fully occupying most of the cars and supplying the fuel to drive this train, is the powerful pharmaceutical manufacturers association (the drug companies). The government, which in case you forgot is actually you--the taxpayer--pays the costs for this free or nearly free ride. Now to be fair, there is a strong assumption that certain people's lives have seen its quality increase due to access to these free or reduced drug price program. However, what has been the most vivid observation for me, the pharmacist, has been the egregious over-prescribing to many Part-D eligibles. Many individuals wind up swallowing a virtual drug-soup. A cocktail of un-needed redundancy and excess. The health train of "good intent" has removed the consumer as the arbiter of sale or no sale. The person taking the drugs has no interest in the cost since it does not directly effect their pockets. Its either "free" or costs a few dollars. With costs removed from the equation, the doctors and patients pile on the drugs. Different doctors different drugs. Costs to taxpayers escalate, patient quality of life deteriorates, health outcomes diminish, yet the train of "good intent" inexorably rolls on. Our American healthcare scenerio is complex tangle of many players which has developed over the decades. This drug portion is but a small part of the health-drug-business industry. Many areas are profiting handsomely from the status quo and do not care to re-shape the set.

Constipation: an inside joke, but no ha-ha

CONSTIPATION: Not a converstation you strike up with strangers at the airport. Probably the last topic you discuss while on a date: "Paula tell me about your stool? Is it loose and watery, or lumpy and sausage-like?" We spend millions of dollars talking about what we put in our mouths, but what about how we let that stuff out? Bowel movements are essential to life and sustained health. There is a big difference between chronic and occasional constipation. Some people have the idea they need to have bowel movement every single day. Others may go a two or three days without releasing their innards. Occasional constipation is typically experienced by a change in your routine behavior- a different diet, decreased fluid intake, emotional changes, decrease in exercise, all could precipitate occasional constipation. This short-term disruption in fecal expulsion is usually relieved by returning to normalcy of routine and/or over-the-counter (OTC) medications. Chronic constipation should not be confused with (IBS) irritable bowel syndrome. IBS is usually accompanied by abdominal pain and gut discomfort. Most of us don't experience chronic constipation. But if you can't go to the bathroom even for 3-5 days, the plane get overcrowded and uncomfortable; someone has to disembark. How do you handle occasional constipation:

1. Lubricants
2. Bulking agents
3. Stool softeners
4. Osmotics
5. Combinations

All of these constipation relieving categories involve water. Water to coat the stool, water absorbed to bulk the stool, a coating to keep water in the stool, water to mix with the stool. It doesn't take a genius to see the relationship of adequate water intake to normal bowel movements. You must drink enough water to allow the OTC medicine to work. Before you buy any medication, try walking on the beach, or at least around the block a couple times. If you are fat, and out of shape, talk with your doctor first before beginning exercise routine. Bottom line is exercise is the best medicine for ensuring regularity unless there is an underlying physical anamoly. Talk to your pharmacist about what is the best laxative for your particular condition. S/he will be happy to make some recommendations that will get things moving again. Or send me a line with about your health issues and my team of consultants and myself will create a plan for you. Email me at RPelhamSr@gmail.com.

I have been a pharmacist for over thirty years. All my life, I have been fascinated with the chemicals (nutrients) we feed this marvelous chemistry lab we call our body. It is a mysterious, spiritual and physical self-contained universe. We have discovered many of its workings, yet many lifetimes of work remain. For now, let us share in our personal discoveries (good and bad). I will shape the conversation on prescription and non-prescription drugs and the hundreds of herbs, vitamins, minerals and trace elements waiting to be swallowed, injected or applied. Let the journey begin...