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Re: [IP] pumper pals

i thought this might be of interest to some of you--concerning undertreatment
of people with chronic diseases.  it was interesting to me.  this was from
john hopkins website.  ellen


Treating Chronic Diseases, Neglecting Others

<Picture: UPI Logo>May 21, 1998

BOSTON (UPI) - Doctors may have a one-track mind when it comes to patients
suffering from several chronic diseases and they may be neglecting to treat
serious illnesses, say Canadian researchers. 

In a study of more than 1.3 million Ontario residents over age 65, scientists
from the University of Toronto and Sunnybrook Health Science Center
investigated treatment patterns for three diseases - diabetes, emphysema and

The researchers write, ''our findings suggest a shortfall in health care -
specifically, that unrelated disorders are relatively neglected in patients
with chronic medical conditions.'' 

Dr. Donald A. Redelmeier, of Sunnybrook in Toronto, lead investigator, calls
the problem, ''small but significant.'' He predicts it is going to take on
greater proportions as the baby boomers age. He says, ''If you live long
enough you are likely to develop more than one chronic disease.'' 

They investigated how often patients with these conditions were given drugs
for common, but unrelated conditions: estrogen for diabetics; lipid lowering
drugs for people with emphysema and arthritis medicine for patients with
psychotic syndromes. 

Women with diabetes were 60 percent less likely to get estrogen therapy, even
though they are at higher risk of having heart disease, the scientists found. 

People with emphysema got 31 percent fewer lipid lowering drugs, even though
the odds are that the lung condition was brought on by smoking, which is known
to clog arteries. 

Psychotics were 41 percent less likely to be given arthritis medicines, even
though joint pain might increase their mental distress, the scientists say. 

The scientists say, ''In all three examples, inadvertent undertreatment may
have consequences.'' 

The researchers are not sure why doctors neglect to prescribe drugs for
unrelated conditions. 

Cost was most likely not a major factor, because medications are provided free
of charge to these patients, say the investigators. 

It may be the fault of busy doctors striving to keep care simple, or who worry
that too many drugs could hurt patients with more than one serious condition. 

It may also be the wishes of chronically ill or elderly patients, who can't
handle a complicated medication schedule or who fear that the interactions of
several drugs could make their problems worse. 

In an editorial in the NEJM, Dr. Robert Steinbrook, of the journal's editorial
board, says that the study, ''raises as many questions as it answers, but they
are questions well worth asking.'' 

He says other studies are needed to see if undertreatment is a problem in
other groups of patients and in other countries. 

Copyright 1998 UPI. All rights reserved. 

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