Unlike Dick the Butcher

Unlike Dick the Butcher

• Unlike Dick the Butcher

• ”The first thing we do, let's kill all the lawyers”
• Not: medications are bad
• Rather, suggesting need for judicious use and continuous re-litigation

Demographics

• Demographics

• Aging and Multimorbidities
• Polypharmacy and ADR’s

• Age-related changes

• Pharmacodynamics (absorption, clearance)
• Body Composition

• What are we doing? Whose standard?

• Bad Drugs: Beer’s List, HEDIS High Risk Meds

• Semper Vigilentes – Med Review as a SOP

Population Explosion

• Population Explosion

• Where we are:
• Over 65 years old: 12.9% of population
• Over 75: 6.1% 18,766,000
• Where we’re going

Compression of Morbidity

• Compression of Morbidity

Large heterogeneity  difficult to find applicable studies

• Large heterogeneity  difficult to find applicable studies

• “No index…prospectively tested and found to be accurate in a large diverse sample…no study was completely free from potential sources of bias. Testing of transportability was limited, raising concerns about overfitting and underfitting. These factors limit a clinician's ability to assess the accuracy of these indices across patient groups that differ according to severity of illness, methodology of data collection, geographic location, and time.”
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