It’s important to talk about medication

Pharmaceutical firms can be eager to sell drugs and doctors keen to dispense them

When it comes to pharmaceuticals, seniors tend to be super users. Two-thirds of those in long-term care facilities take 10 or more medications, according to a 2012 Canadian Institute for Health Information (CIHI) report.

Even among active older Canadians, pharmaceutical use is high. A poll of 5,190 CARP members in July revealed that, while 10 per cent use no prescription medications, CARP members are prescribed four medications each on average and five per cent take 10 or more.

These medications can improve our quality of life or extend our days, but they can also bring side-effects and harmful drug interactions. Should we just quietly take our medicine?

The answer comes down to math and the difference between relative and absolute risks. Imagine that you have a one in 100 million chance of winning the lottery. If your chances double, you have a one in 50 million chance. Doubling your chances (the relative change) sounds like a lot, and we may be tempted to buy a lottery ticket. But even doubled, a one in 50 million chance is still a heckuva long shot — so on reflection, we may prefer to save our money.

We need to assess our medications in the same way. Our doctors will prescribe medications because they decrease the risk we’ll experience something nasty like a seizure, uncontrolled pain, high blood pressure or other ailments. While the relative decrease in risk is often high, sometimes the absolute change isn’t worth the side-effects or potential for negative drug interactions.

Take the case of Lipitor, a statin drug marketed by Pfizer to reduce your risk of a heart attack by 36 per cent.

That sounds like a highly significant reduction of risk. But is it? The fine print notes “in a large clinical study, three per cent of patients taking a sugar pill or placebo had a heart attack compared to two per cent of patients taking Lipitor.”

A 36 per cent relative decrease equates to a one per cent absolute decrease.

That doesn’t sound nearly as compelling. It’s even less compelling if we frame it in reverse. Imagine if the ad noted “taking a sugar pill or placebo will keep 97 per cent of people from having a heart attack, taking Lipitor will protect 98 per cent.”

No drug will give us immortality, but they can prolong our days. While the Pfizer ad is silent on the impact of Lipitor on our longevity, the British Medical Journal is not. A 2015 study published in the journal examined the impact of statins (like Lipitor) on longevity.

The study reviewed the results of 11 detailed studies of statins and longevity. Its conclusion: The median postponement of death for primary and secondary prevention trials were 3.2 and 4.1 days, respectively. The median is the midpoint, so about half of the folks studied had their lives extended by less than three or four days and the other half by more.

With pharmaceutical companies eager to sell drugs and doctors keen to avoid problems, the default is often defensive medicine — more treatments are recommended than we might want or need.

Does this mean you should stop taking Lipitor or other statins? Not necessarily. But it’s important to talk with your doctor or pharmacist about the absolute benefit of all the medications you are taking and ensure that the benefits outweigh any sideeffects or drug interactions.

To see the complete CARP pharmacare poll, go to www.carp.ca/news.

Grey Matters is a weekly column by Wanda Morris, the VP of Advocacy for CARP, a 300,000 member national, non-partisan, non-profit organization that advocates for financial security, improved health-care for Canadians as we age. Missed a week? Past columns by Wanda and other key CARP contributors can be found at carp. ca/ blogs.