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Showing posts with label Safety. Show all posts
Showing posts with label Safety. Show all posts

Thursday, August 21, 2025

Juggling multiple medications

 

Taking many drugs at one go may be necessary, especially for less healthy older adults, but we must be aware of the potential dangers.


There are times when it is necessary for a patient to take multiple drugs daily as they suffer from a few chronic medical conditions, but their regime should be regularly reviewed to ensure all the drugs they are on are still necessary. — Pexels

The Malaysian population is rapidly ageing, with over 11% currently aged 60 and above.

This figure is projected to rise to 17.3% by 2040.

The demographic shift has led to increasing healthcare demands, particularly in managing chronic diseases such as diabetes, hypertension (high blood pressure) and heart disease.

These conditions require long-term medicine use.

Alarmingly, studies indicate that nearly half of older Malaysians experience polypharmacy.

Many are also prescribed potentially inappropriate medications or fail to adhere to their treatment regimens.

This issue calls for coordinated care, increased awareness and targeted interventions.

Understanding polypharmacy

Polypharmacy is generally defined as the use of five or more medicines at the same time.

However, the number of medicines alone does not determine the impact.

The necessity and appropriateness of these medicines are equally important.

Polypharmacy can be both beneficial and harmful.

Appropriate polypharmacy occurs when multiple medicines are clinically necessary, carefully monitored and effectively managed.

For example, a person with high blood pressure, diabetes and heart disease may require several medicines to maintain stable health.

Problematic polypharmacy occurs when medicines are prescribed to treat the side effects of other medicines (a situation known as a prescribing cascade), or when the medicines themselves are potentially harmful.

Polypharmacy is common among older adults for several reasons.

Understanding these contributing factors is essential in order to design effective strategies to minimise medicines-related harm and improve overall patient care.

Some of the factors that can be attributed to the high frequency of polypharmacy among older adults are:

  • The presence of multiple chronic medical conditions, for which the long-term use of medicines is necessary,
  • Prescription of medicines on multiple different occasions by different healthcare practitioners, which increases the risk of duplication or drug interaction.
  • Prescribing cascades, where medicines are prescribed to treat the side effects caused by other medicines.
  • The absence of regular medicine reviews, which may allow unnecessary or outdated prescriptions to continue without reassessment.
  • Poor communication between patients and healthcare providers, which can result in confusion or misuse of medicines.
  • Widespread and accessible pharmaceutical promotions, which encourage patients to use traditional or over-the-counter medicines alongside prescribed medicines without medical advice.

Potential dangers

Polypharmacy carries genuine and significant risks, especially for older adults.Community pharmacists are one resource patients can easily access to ensure that their medicine regime is up-to-date and not causing any unnecessary side effects. — FilepicCommunity pharmacists are one resource patients can easily access to ensure that their medicine regime is up-to-date and not causing any unnecessary side effects. — Filepic

Due to slower metabolisms and potentially impaired kidney function, the elderly are more vulnerable to the negative effects of multiple medicines.

Some of the most concerning consequences include emergency hospitalisations due to medicine-related complications, drug interactions that lead to undesirable side effects or reduced effectiveness, and adverse side effects such as dizziness, confusion or gastrointestinal issues.

In addition, when medicines impair alertness or physical coordination, they may contribute to falls, fractures and cognitive decline.

Several studies conducted in Malaysia also show that the majority of older adults do not take their medicines as prescribed.

Polypharmacy has a direct impact on medication adherence, which refers to how well patients follow their prescribed treatment plans.

As the number of prescribed medicines increases, the elderly often struggle with complex dosing schedules, leading to missed or incorrect doses.

This not only compromises treatment outcomes, but also increases the risk of hospitalisations and complications.

To address these, it is essential to provide patient education, simplify medicine regimens, and offer support through technology and caregiver involvement.

Reducing the risks

Healthcare systems around the world are adopting more proactive strategies to ensure the safe and effective use of medicines, especially in light of growing concerns about polypharmacy.

One important strategy is regular medicine reviews.

Patients are encouraged to inform their doctors and pharmacists about all the medicines they are taking, including prescriptions, over-the-counter products and supplements.

This open communication allows more regular medicine reviews, which helps healthcare providers identify medicines that may no longer be necessary or could be potentially harmful.

Another key practice is deprescribing, which involves gradually reducing or stopping medicines that are no longer beneficial.

Medicine reconciliation is also essential.

This process ensures that any changes to a patient’s medicine list, such as during hospital admission, discharge or transfer to a nursing home, are accurate and appropriate.

Technology also plays a helpful role.

Electronic health records can alert healthcare providers to potential interactions or duplicate medicines.

Most importantly, a patient-centred approach is needed.

When patients are involved in decisions about their treatment, it builds trust, improves adherence to medicines and leads to better health outcomes.

The most effective strategies to manage polypharmacy involve active participation from both patients and their caregivers.

Several steps are encouraged to support safe medication use:

  • Maintain an updated medicines list, including over-the-counter products, supplements and herbal remedies.

    Bring this list to every medical appointment.

  • Ask your doctor or pharmacist about the purpose, benefits and possible side effects of each medicine.
  • Inform your doctor or pharmacist when you experience side effects, especially if they are suspected to be caused by a medicine.
  • Get help from pharmacists for medicine reviews, especially after hospital stays or when there is a change in the medicine regimen.
  • Use adherence devices or tools to help take medicines correctly, such as pill boxes, mobile apps or mobile alarms.

The role of pharmacists

As the number of elderly individuals taking multiple medications daily continues to rise, the role of pharmacists has become increasingly vital.

While doctors are responsible for diagnosing conditions and prescribing treatments, pharmacists ensure that medications are used safely, correctly and effectively.

With specialised knowledge in pharmacology and drug interactions, pharmacists are often able to detect issues that may be overlooked by others.

These include overlapping therapies, potentially harmful drug combinations, and unnecessary or duplicate prescriptions.

Community pharmacists, in particular, are in a unique position to support patients directly.

As the most accessible healthcare professionals, they can offer personalised counselling, conduct routine medication reviews and help patients understand the purpose and proper use of each medicine.

They can also identify early signs of adverse effects or non-adherence, and refer patients for further medical attention when necessary.

Addressing polypharmacy requires a coordinated approach that centres on the patient.

As the population grows older, providing safe, effective and individualised treatment is crucial.

Balancing illness management with quality of life is key to delivering better and safer care to older adults.

For any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

By PAYAL CHOUDHURY

Payal Choudhury is a pharmacist at Hospital Tengku Ampuan Najihah in Kuala Pilah, Negri Sembilan. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division.

For more information, email starhealth@thestar.com.my.

The information provided is for educational and communication purposes only, and should not be considered as medical advice.

The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The

Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Juggling Multiple Meds: Doctors and the Ninth Prescription

https://www.linkedin.com/pulse/pills-should-more-than-color-day-alan-pitt-m-d-/

Several years ago, when prescribed a single medication to be taken daily for several months, I found it very difficult to remember to take it every day. I knew it was important and I knew why I was taking it, but even then I forgot. That experience got me thinking about the many people who are asked to take six, seven, ten drugs a day…forever. I have no idea how they remember to take all of these drugs correctly, and the fact is, most people don’t. This was made clear to me as early as my residency, when it was not uncommon for people to bring in garbage bags full of medicines. When asked how they determined which ones to take and when, these patients often seemed to go by the pill color of the day rather than any set schedule or plan. 

In fact, the data on this issue—known as medical compliance—reveal an abysmal record of patients’ taking medications “as prescribed.” Reportedly less than one third of diabetic patients take metformin correctly. And only half the patients with high blood pressure take even 80% of their medications as prescribed. The end result is a multi-billion-dollar expense with unpredictable and often dangerous outcomes. How does this happen? 

Unfortunately, when it comes to prescriptions, providers are required to be compulsive. We are trained not only to address every problem with a solution, but also to do so on an individual basis. If you have asthma, there's a treatment for that. If it’s heart disease, here’s another pill. Diabetes? Take three more. The list grows quickly, adding expense and, more alarmingly, often resulting in untoward drug-drug interactions. It’s gotten so bad you’d be justified in thinking certain providers delusional for even believing the patient could take the list of medications “as prescribed.” Yet, when you talk to physicians about this issue, many simply shrug their shoulders. They’ll tell you they have little choice. The current medical legal climate requires a response to each identified problem.

One solution to this quagmire is personalized medicine, a topic I’ve discussed in prior posts. I should note that personalized medicine means different things to different people, but for many, America's love affair with technology often translates personalized medicine into genomic medicine. Eric Topol wrote extensively about this in his book  Creative Destruction of Medicine, explaining how, through sequencing the genome, doctors will be able to predict how each individual will respond to a particular drug. Equipped with such powerful tools, it’s not hard to imagine a future pharmaceutical industry that could customize medications, rather than simply produce mass quantities that work "well" for the average person. 

Until that particular biotech future arrives, I think there is a far simpler and immediate opportunity open to personalized medicine: by identifying a patient's ability to participate in her own care and then matching the medication regimen not only to her needs and preferences, but to subjective criteria such as mental clarity, alertness, daily routines, family support, etc. Two people with exactly the same list of problems may have very different abilities and willingness to take a complex regimen of medications. A 50-year-old executive may have the same problem list as an 80-year-old nursing home patient, but will clearly have different organizational skills, financial resources as well as an understanding of why the regimen matters. For physicians to write prescriptions they know deep down their patients cannot take borders on the absurd and certainly does not constitute good care. 

Although I'd like to think physicians would read this and suddenly change the way they write prescriptions, I am not that naïve. Without a significant change in how we're trained as well as appropriate protections from medical legal risk, it's unlikely doctors will suddenly change the way they practice. However, you as the patient have an opportunity to ask the questions. Are all of these medicines necessary? And if I only take a portion of the drugs, what is the overall increased risk to my health?  If you find yourself simply unable to follow the regimen, have an honest conversation about alternatives. Remind your doctor that you are not a “problem list” but an individual with specific medical requirements and concerns.

Ultimately, treating problem lists instead of people may be “right" but it's not reasonable. 

Friday, August 15, 2025

Cyber scams rising sharply; Scam victims face trauma of losses

Home Ministry ramps up efforts as losses hit rm1.12bil



ONLINE scams in Malaysia have caused a staggering Rm1.12bil in financial losses in just the first half of 2025 alone, says the Home Ministry.

It said that the government would begin intensifying its efforts and curb online scam losses in the country, which include strengthening the National Scam Response Centre (NSRC), in response to the growing scam cases.

The ministry said this would involve the creation of new positions involving various schemes.

“Prime Minister Datuk Seri Anwar Ibrahim has also agreed for the NSRC to be placed under the direct supervision of the Home Ministry. It has also been decided that it will be led by the police force,” the Home Ministry said in a parliamentary written

“Prime Minister Datuk Seri Anwar Ibrahim has also agreed for the NSRC to be placed under the direct supervision of the Home Ministry.” Home Ministry

reply to R. Yuneswaran (Phsegamat) on the amount of money lost by Malaysians due to online scams and the steps being taken to address the issue.

The ministry also said it is studying the feasibility of drafting a Cybercrime Bill as part of its efforts to combat cybercrimes in the country. It added that its Semakmule portal, which enables the public to check bank account numbers, phone numbers and companies used by scammers, currently has 265,869 bank accounts, 211,265 phone numbers, and 12,724 company names recorded.

On Aug 5, the Digital Ministry said online scam financial losses in 2024 reached a worrying Rm1.58bil, a 2.53% increase from the year prior.

It was reported earlier that to cope with an average of 500 scamrelated calls per day, the government has approved an additional 139 permanent staff for the NSRC.

In the interim, 40 Commercial Crime Investigation Department personnel have been deployed to assist operations.

Currently, the NSRC is supported by personnel from the police, Bank Negara, calling agents appointed by the central bank and bank officers.

Home Minister Datuk Seri Saifuddin Nasution Ismail said the NSRC’S operations will be relocated to Cyberjaya by early September to allow all agencies to work under one roof.

Scam victims face trauma of losses

https://www.thestar.com.my/news/nation/2025/08/15/scam-victims-face-trauma-of-losses
M'sians whose money vanished also have sleepless nights and trust issues. PETALING JAYA: At 5am on April 1, 2023, Lawrence was jolted awake .

Thursday, August 14, 2025

US national debt hits record $37 trillion amid mounting fiscal concerns


Photo taken on March 17, 2020 shows U.S. dollar banknotes in Washington, DC, the United States. Photo:XinhuaThe US government's gross national debt has surpassed $37 trillion, a record number that highlights the accelerating debt on America's balance sheet and increased cost pressures on taxpayers, the AP reported. The $37 trillion update is found in the latest Treasury Department report issued on Tuesday, which logs the nation's daily finances, according to the AP report.

Experts said that as the debt scale grows larger, future interest payment costs will continue to rise, posing risks to fiscal sustainability, while global investors may grow wary of US Treasury bonds amid credit downgrades and uncertainty.

The $37 trillion debt milestone comes less than eight months after the nation hit the $36 trillion threshold for the first time in late November 2024, and a little over one year after the $35 trillion mark was reached in late July 2024, Fox Business reported.

The $37 trillion debt amounts to about $280,000 per household or $108,000 per person, according to the Peter G. Peterson Foundation.
 
The national debt soaring past $37 trillion sends yet another clear message about America's unsustainable fiscal path, Chair and CEO of the Peter G. Peterson Foundation Michael Peterson said in a statement on its website.

"Our growing debt slowly damages our economy and the prospects of the next generation. As the government borrows trillion after trillion, it puts upward pressure on interest rates, adding costs for everyone and reducing private sector investment. Within the federal budget, the debt crowds out important priorities and creates a damaging cycle of more borrowing, more interest costs, and even more borrowing," Peterson said.
 
The Government Accountability Office outlines some of the impacts of rising government debt on Americans — including higher borrowing costs for things like mortgages and cars, lower wages from businesses having less money available to invest, and more expensive goods and services, according to the AP.
 
The Joint Economic Committee estimates at the current average daily rate of growth, an increase of another trillion dollars in the debt would be reached in approximately 173 days, according to the AP.

Peterson warned that "As our debt continues to rise, at some point the financial markets will lose confidence in our ability to overcome the politics to solve this problem."
 
To repay maturing debt, the US government has been issuing new debts to repay old ones, leading to the continuous expansion of the overall debt load. As the debt scale grows larger, it means that the future interest payment costs will continue to rise, posing risks to fiscal sustainability, Zhou Mi, a senior research fellow at the Chinese Academy of International Trade and Economic Cooperation, told the Global Times on Wednesday.

If maturing debts cannot be repaid, US debt will become unsustainable, and its credit ratings may be downgraded, creating significant risks for global investors, Zhou added.

The expansion of the US government's debt scale has brought more uncertain risks to investments in US Treasury bonds, making global investors more cautious, Zhou said.

"Factors such as rating agencies' changes in sovereign credit ratings and sharp swings in US tariff policies at the real-economy level have added to this uncertainty," Zhou added.

Yang Changjiang, a professor at Fudan University, told the Global Times on Wednesday that the expanding US government debt has also brought greater uncertainty to the global financial market and the stable operation of the international monetary system.

In May, Moody's downgraded the US sovereign credit rating. It is expected that US large-scale fiscal deficits will further increase the burden of government debt and interest payments, and the fiscal situation is likely to deteriorate, Yang said.

Moody's Ratings in May cut the US' sovereign credit rating by one notch to Aa1 from Aaa.

"This one-notch downgrade on our 21-notch rating scale reflects the increase over more than a decade in government debt and interest payment ratios to levels that are significantly higher than similarly rated sovereigns," said a release by Moody's Ratings. 

The US fiscal performance is likely to deteriorate relative to its own past and compared with other highly rated sovereigns, according to the credit rating agency.

The downgrade means the US has lost its last triple-A credit rating from a major ratings firm, following cuts by Fitch Ratings in 2023 and S&P Global Ratings in 2011, according to Xinhua.
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Thursday, June 12, 2025

Be prepared to face hotter days

 

Experts warn of wet-bulb temperatures for those vulnerable to heatstroke 

 As global warming ratchets up, Malaysians should prepare to face hotter and muggier days during the dry spell brought about by the annual Southwest Monsoon, say weather experts.

Along with this, it is also time to pay attention to not just dry-bulb readings provided by the typical thermometer but also wet-bulb temperatures (WBT), which scientists say are important to those who are vulnerable to heatstrokes or related ailments.

WBT is an indication of how much the air can be cooled by the evaporation of water into it and is usually measured using a thermometer with the bulb covered by a wet membrane, with higher WBT signalling an increased risk for the vulnerable.

WBT and high humidity are often missed during reporting on heatwaves, even though they play a huge role in how a person experiences heat.

Academy of Sciences Malaysia’s fellow Dr Fredolin Tangang said while the Southwest Monsoon season is usually marked by hot and dry weather, global warming could be contributing to even hotter conditions.

“According to the latest observation, the first quarter of 2025 was the second warmest year compared to the corresponding period in 2024, which was the warmest year on record.

“This despite La Nina being active during the first quarter of this year,” he said when contacted.

The APEC Climate Center in (South) Korea, he said, indicated that the surface air temperature over the Indo-pacific region is 80% above normal during the current monsoon period this year.

“Also, the sea surface temperature (SST) was forecasted to be above normal.

“High SST could drive higher relative humidity, and this increases the WBT and also the heat index, creating favourable conditions for heatstrokes,” he said.

Fredolin suggested that the relevant authorities should provide an early warning system to the public to be alert for excessive heat and humidity.

“More public announcements of the danger of heatstroke and how to avoid getting one should be regularly broadcast, while the public should not take lightly the extreme conditions that heighten the risk for heatstrokes,” he said.

A 2023 paper published by researchers from Universiti Teknologi Malaysia raised concerns about the future emergence of urban areas as hotspots for heat stress, particularly in peninsular Malaysia.

Their study showed a notable increase in the mean temperature over the peninsula, surpassing the global average, which could lead to a substantial increase in WBT, especially in dense urban regions.

According to National Antarctica Research Centre climatologist Prof Datuk Dr Azizan Abu Samah, there is a high chance the Asean region will see above-normal temperatures between June and August, based on several predictive models.

“The inter-monsoon period typically transitions into the Southwest Monsoon over the Asean region in June and will continue throughout the outlook period,” he said, while advising the people to minimise their exposure to the blistering sun as much as possible.

Meteorological Department’s (Metmalaysia) director-general Dr Mohd Hisham Mohd Anip said the main cause for current hot and humid weather is the Southwest Monsoon that began on May 10, with the phenomenon expected to continue until September.

“This monsoon typically brings dry weather to most parts of the country.

“However, thunderstorms and heavy rain may still occur from time to time,” he said.

Mohd Hisham added that the extended absence of rain over several days could result in searing conditions similar to what happened earlier this month.

On June 2, Metmalaysia issued a Level 1 heat advisory in six areas in the peninsula which experienced maximum daily temperatures of between 35°C and 37°C for three consecutive days.

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