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We Use Too Many Medications: Be Very Afraid of Interactions

By HANS DUVEFELT

I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics and risperidone: Elderly dementia patients on risperidone have twice their expected mortality if also given furosemide. I knew that all atypical antipsychotics can double mortality in elderly dementia patients, but was unaware of the additional risperidone-furosemide risk. Epocrates only has a nonspecific warning to monitor blood pressure when prescribing both drugs.

This is only today’s example of an interaction I didn’t have at my fingertips. I very often check Epocrates on my iPhone for interactions before prescribing, because – quite frankly – my EMR always gives me an entire screen of fine print idiotic kindergarten warnings nobody ever has time to read in a real clinical situation. (In my case provided by the otherwise decent makers of UpToDate.)

I keep coming back in my thoughts and blogging about drug interactions. And every time I run into one that surprised me or caused harm, I think of the inherent, exponential risks of polypharmacy and the virtues of oligopharmacy.

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Surveyor Health demystifies clinical pharmacy

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By MATTHEW HOLT

In some interesting news this week, Inland Empire Health plan (IEHP), a major Medicaid health insurer in southern California with about 1.2 million members, and its contractor Preveon Health announced that they were “extending a pilot” with Surveyor Health, for their MedRiskMaps product.

This is interesting for a bunch of reasons. First it’s a good example of how technology is now being applied to help with the almost absurd complexity of modern medicine–complexity that technology has both added to and may yet cure. Secondly, Surveyor Health has been building its technology for several years and (FD) I’ve been advising them off and on since 2009 and know the principals well. Thirdly, and this is mostly for grins, it represents some of the absurd language used to describe our crazy health care system.

What does the tech do? Surveyor Health’s technology is very complex optimization technology that examines the incredible number of symptoms and interactions undergone by patients taking multiple medications. As you know most chronically ill patients are on upwards of half a dozen medications and some are on many more. The more medications, the more the potential for serious and sometimes fatal drug-drug interactions, side effects and more. You only have to think of the litany of celebrity drug deaths (Michael Jackson, Prince, Anna Nicole Smith, Health Ledger, Tom Petty, to name a few) to understand the seriousness of the issue. Erick von Schweber, a real theoretical physicist and CEO of Surveyor Health tells me that when you get above 11 drugs the calculations involved are more complex than what Google has to do to index the web. (And yes, he now is allowing me to call it AI!)

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What has Surveyor Health been up to?

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By Matthew Holt

Erick & Linda von Schweber started Surveyor Health around the time Health 2.0 started back in 2007, with the BHAG of massively improving medication safety using some very complex technology. And it has taken them a long time to embed themselves in the bowels of some huge health care organizations and to start getting traction. But it is finally happening and the impact may be substantial. I interviewed Erick and he gave me a comprehensive demo and update on their latest results. If you care about drugs and clinical care, this is compelling (if not lightweight!) viewing. (I suggest you switch to full screen for the demo).

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