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Older patients become more susceptible to drug-induced dementia and
delirium as they age, but the symptoms are often overlooked by doctors
who don't realize that the condition may be caused by drugs and
reversed, Public Citizen writes in a Worst Pills, Best Pills News article released today on WorstPills.org, the organization's drug safety Web site.
Unlike most forms of dementia, such as Alzheimer's disease, which
cannot be reversed, dementia caused by prescription drug use may be
stopped by discontinuing the offending medication. The drug safety
experts at Public Citizen have identified 136 commonly prescribed
medications, especially certain antidepressants and pain medications,
that can cause difficulty thinking.
Drug-induced dementia and delirium are commonly misattributed to
underlying medical illness or merely to "old age." But by stopping or
modifying the dosage of numerous, frequently prescribed drugs, most
patients can be restored to a pre-drug state of mental clarity.
Older people are more susceptible to drug-induced delirium and
dementia because the body's ability to rid itself of drugs decreases
with age, often because of normal age-related decrease in kidney and
liver function. Also, older patients are often prescribed multiple
drugs at the same time, resulting in complicated interactions and
enhanced side effects. Some research also suggests older patients'
brains may be more sensitive to drugs' effects on the central nervous
system.
"Sadly, doctors don't always recognize cognitive impairment as a
side effect, so many patients needlessly suffer from this debilitating
but reversible condition," said Sidney Wolfe, M.D., director of Public
Citizen's Health Research Group and acting Public Citizen president.
"After beginning new drugs, doctors, patients and their families should
watch for subtle changes in cognition and assume changes may be caused
by drug therapy. People already suffering from some cognitive
impairment are most susceptible."
Delirium is a syndrome of changes in vision, hearing and thinking
that usually starts abruptly and is commonly seen in the hospital
setting or during an acute illness; symptoms typically improve when the
cause is treated. Dementia, on the other hand, is a chronic alteration
in thinking that progresses slowly. Alzheimer's disease is dementia's
most common cause, but it also can be caused by strokes and other
conditions.
WorstPills.org includes the
full list of 136 implicated drugs. Some examples include: widely used
antihistamines such as diphenhydramine (Benedryl); a drug widely used
for treating urinary incontinence, tolteridine (Detrol); a nausea
treatment drug, metoclopramide (Reglan); and drugs in the
benzodiazepine category such as popular sleeping pills Ambien
(zolpidem) and Lunesta (eszopiclone).
Worst Pills, Best Pills News is a monthly newsletter available in print and electronic formats through Public Citizen's subscription Web site, . The article about drug-induced dementia and delirium will be available free for the next seven days. The site has other searchable information about the uses, risks and side effects associated with prescription medications.
WorstPills.org is an
unbiased analysis of information from a variety of sources, including
well-regarded medical journals and unpublished data obtained from the
Food and Drug Administration, that allows Public Citizen to sound the
alarm about potentially dangerous drugs long before they are banned by
the federal government and to recommend safer drugs. For example,
Public Citizen warned consumers about the dangers of Vioxx, ephedra,
Baycol and Propulsid years before they were pulled from the market.
Public Citizen is a nonprofit consumer advocacy organization that champions the public interest in the halls of power. We defend democracy, resist corporate power and work to ensure that government works for the people - not for big corporations. Founded in 1971, we now have 500,000 members and supporters throughout the country.
(202) 588-1000"It comes as little surprise that Mr. Crow is doubling down on bogus legal theories as he continues to stonewall basic questions about his gifts to Clarence Thomas and his family."
U.S. Senate Finance Committee Chair Ron Wyden on Tuesday said that "nothing is off the table"—including a subpoena—after a lawyer for Republican mega-donor Harlan Crow continued to duck questions about the billionaire's gifts to Supreme Court Justice Clarence Thomas and his relatives.
In a June 2 letter to Senate Judiciary Committee Chair Dick Durbin (D-Ill.), Crow attorney Michael Bopp expressed "respect" for the panel's "important role in formulating legislation concerning our federal courts system," while stating that he would "welcome a discussion with your staff."
However, Bopp also reiterated his assertion that "Congress does not have the power to impose ethics standards on the Supreme Court" and "therefore cannot mount an investigation for the purpose of helping craft such standards."
"It comes as little surprise that Mr. Crow is doubling down on bogus legal theories as he continues to stonewall basic questions about his gifts to Clarence Thomas and his family."
Thomas and Crow have repeatedly refused to answer questions about years of gifts—including luxury vacations and private school tuition—to the right-wing justice and members of his family.
In response to Bopp's assertion—which has been roundly refuted by Durbin and legal experts—Wyden, a progressive Oregon Democrat, accused the Gibson Dunn partner of "stonewalling."
"It comes as little surprise that Mr. Crow is doubling down on bogus legal theories as he continues to stonewall basic questions about his gifts to Clarence Thomas and his family. If anything, the most recent letter from his attorney raises more questions than it answers," the senator said in a statement.
\u201cHarlan Crow continues to stonewall over his gifts to Clarence Thomas. Nothing is off the table as I discuss next steps with my Finance Committee colleagues to compel answers to our questions from Mr. Crow, including by subpoena. Those discussions will continue.\u201d— Ron Wyden (@Ron Wyden) 1686059917
"The letter states, 'charter rates or reimbursements at rates prescribed by law were paid to the Crow family entities' with zero additional detail that could help clarify these financial arrangements, such as exactly who made those payments for Justice Thomas' extravagant luxury travel, and how many times and in what amounts those payments were made," Wyden continued.
"Far too often, efforts to investigate real-life tax practices of the ultra-wealthy and powerful end with this kind of vague, carefully-worded assurance that everything is on the level. That's simply not good enough," he argued. "This is exactly why the Finance Committee is pursuing this matter as part of its broader review of gift and estate tax practices of ultra-high net worth individuals."
Wyden added: "I've already begun productive discussions with the Finance Committee on next steps to compel answers to our questions from Mr. Crow, including by subpoena, and those discussions will continue."
The senator appeared at the summit days after pushing through language in the debt ceiling bill that will expedite the permitting process for the Mountain Valley Pipeline.
Organizers of a summit on so-called "permitting reform" hosted by the fossil fuel-linked news outlet Semafor were forced to delay the event on Tuesday when several climate campaigners interrupted Sen. Joe Manchin's remarks to protest the Mountain Valley Pipeline, a pet project of the right-wing West Virginia Democrat.
About two dozen protesters assembled on the stage at the event just as Manchin began speaking about his desire to speed up the approval of projects like the Mountain Valley Pipeline (MVP), a $6.6 billion fracked gas project that would run from the senator's home state to Virginia, passing through wetlands and waterways.
"Dirty deal, MVP, Manchin, you are killing me!" chanted the demonstrators, who Bloomberg Law reported were representing the direct action group Climate Defiance. The group also sang the song "Take Me Home, Country Roads."
\u201cBREAKING: We just fully shut down Senator Joe Manchin's keynote address.\n\nHe is shoving a 2,000,000,000 cubic-foot-per-day fracked gas pipeline down our throats. \n\nManchin is not a moderate. Manchin is an ecocidal millionaire. We must resist him with all we've got. And we will.\u201d— Climate Defiance (@Climate Defiance) 1686075030
The demonstration came days after President Joe Biden signed into lawdebt ceiling legislation over the objections of climate campaigners as well as economic justice groups. The so-called Fiscal Responsibility Act includes a requirement that federal agencies approve all remaining permits for the MVP, which has been stalled in the courts as opponents have challenged its threats to the environment in the region the pipeline will pass through. The law also shields the permits from judicial review.
The pipeline is also projected to emit the equivalent of more than 89 million metric tons of carbon at a time when climate scientists and energy experts have warned that fossil fuel emissions must be rapidly drawn down to limit planetary heating to below 2°C above preindustrial levels.
Manchin secured the MVP language in the debt ceiling bill after his previous attempts to include the "dirty deal" regarding expedited permitting in the National Defense Authorization Act and in a stopgap funding bill last year.
The senator left the stage during the protest and claimed the protesters' actions would help him "tremendously" in his state, although polls have shown that West Virginians support a transition to clean energy.
\u201cClimate protesters disrupted Manchin\u2019s Semafor Q&A today on permitting and Mountain Valley pipeline. Speaking now in the back room, Manchin said \u201cwhat these people did today helps me tremendously in my state\u201d politically.\u201d— Ella Nilsen (@Ella Nilsen) 1686065235
Campaigners who have fought the MVP for years have said they will not back down following the passage of the Fiscal Responsibility Act. The People vs. Fossil Fuels coalition is planning a rally in front of the White House on Thursday, and the local group Preserve Bent Mountain in Virginia said Monday that "it is not yet clear whether the stench of the MVP/debt limit deal will surpass legal scrutiny."
"Even if some of these permits are issued and initially shielded from judicial review, that's not necessarily the end of the line," Jason Rylander, senior attorney with the Center for Biological Diversity," told the independent outlet Cardinal News on Monday. "The pipeline still has to cross some of the most difficult terrain along the route, through the Jefferson National Forest and other areas, and there will be opportunities to hold them accountable for the damage they are continuing to do."
"This lawsuit is a desperate attempt by the industry to beat back popular legislation that would curtail Big Pharma's ability to price gouge Medicare," said one consumer advocate.
Merck on Tuesday became the first pharmaceutical company to sue the Biden administration over a recently enacted law that empowers Medicare to directly negotiate the prices of a small number of high-cost prescription medicines with drug makers—a change that could threaten Merck's bottom line.
Filed in a federal court in Washington, D.C., Merck's lawsuit characterizes the drug price negotiation policy established by the Inflation Reduction Act as "tantamount to extortion" and claims the "singular purpose of this scheme is for Medicare to obtain prescription drugs without paying fair market value."
The lawsuit against the Health and Human Services Department (HHS) and the Centers for Medicare and Medicaid Services (CMS) also alleges that the drug price negotiations make "a mockery of the First Amendment" by "conscripting companies to legitimize government extortion."
The suit asks the court to "declare that the program effects compensable takings under the Fifth Amendment, and enjoin its compelled 'agreements' under the First Amendment."
Patient advocates and lawmakers responded with disdain to Merck's lawsuit, which likely won't be the last from an industry that fights aggressively to maintain its power to drive up prices at will. The Centers for Disease Control and Prevention released data last week showing that more than 9 million Americans are delaying medication refills, skipping doses, and taking smaller dosages than prescribed due to high costs.
"Merck is doing everything it can to protect its profits at the expense of patients who need their prescriptions to stay healthy and get treatment for everything from cancer to diabetes," said Sen. Patty Murray (D-Wash.), a senior member of the Senate Health, Education, Labor, and Pensions Committee. "While big drug companies may not want to be at the negotiating table, the American people are sick and tired of giant pharmaceutical corporations putting their executives' paychecks above patients."
Keytruda, Merck's cancer drug, carries an annual list price of $175,000, and the U.S. government has spent billions helping patients cover the cost of the medicine in recent years.
"Merck is claiming the U.S. Constitution requires the U.S. government and people to be suckers. That's not true," Robert Weissman, president of the consumer advocacy group Public Citizen, said in a statement Tuesday. "This lawsuit is a desperate attempt by the industry to beat back popular legislation that would curtail Big Pharma's ability to price gouge Medicare and secure monopoly profits. Full stop."
"While Big Pharma's litigation gambit plays out, it is critical that the federal government continue its preparation for price negotiations," Weissman added. "Delay in the commencement of long-overdue negotiations will result in billions of dollars in excess costs for taxpayers and consumers."
"No one needs to read Merck's fancy lawyer talk or PR spin to know what this is all about—it is about them wanting to continue to fleece taxpayers and gouging seniors."
In September, CMS is expected to release a list of the first 10 Medicare Part D drugs that will be subject to direct price negotiations. Manufacturers of the selected drugs will then have until the following month to sign an agreement to conduct negotiations, and the agreed-upon prices will take effect in 2026.
Dozens of additional prescription drugs covered by Part D or Part B will be subject to price negotiations in the years following 2026. Though the prices of just a small number of drugs will be negotiated under the Inflation Reduction Act provisions, the policy could have a significant impact given that a sliver of medicines accounts for a large percentage of Medicare's prescription drug spending.
The Congressional Budget Office concluded earlier this year that "price negotiation will lower average drug prices in Medicare and will reduce the budget deficit by $25 billion in 2031."
As The New York Timesnoted Tuesday, Merck's Keytruda "could be among the first products targeted when negotiations begin in 2028 on drugs administered in a healthcare setting."
"Merck had been expecting to bring in significant revenue from a new formulation of Keytruda it is developing that can be more easily given under the skin," the Times reported. "That could be subject to negotiation, too, under the government's plans for the program."
Margarida Jorge, head of the Lower Drug Prices Now campaign, said Tuesday that Merck's lawsuit is "nothing but a political stunt motivated by the same shameless greed that we're used to seeing from drug corporations that have made decades of inflated profits at the expense of patients' health and taxpayers' hard-earned money."
"No one needs to read Merck's fancy lawyer talk or PR spin to know what this is all about—it is about them wanting to continue to fleece taxpayers and gouging seniors so they can keep sky-high profits and soaring executive pay," said Jorge. "It's time for big drug corporations like Merck to give up their monopoly control over prices and negotiate fair prices for the medicines we need."