teaching our kids? >> i think it's a catastrophe that so many school disticts have cut arts programs back... >> could his reforms lead to happier, more fufilled lives. >> schools need to encourage the development of imagination... >> sir ken robinson talk to al jazeera only on al jazeera america >> hi, i'm lisa fletcher and you're in "the stream." 9 million americans are taking prescription drugs that may have dangerous interaction. are you one of them? find out in the next 30 minutes. if you're like nearly 70% of americans, you're taking at least one prescription medication, and as you age, that number is likely to go up. >> people are receiving this number of prescriptions, and as you get older, you get more and more prescriptions, and women tend to get more prescriptions than men. >> a ground breaking study shows

that one in five older americans take medication that's work against each other, which can cause serious consequences, and in most case, doctors aren't aware that the patients are on a to collision course with their meds. like common ailment, heart conditions and high blood pressure and diabetes. how did we get to a place where millions of americans are unknowingly facing these dangerous side effects? and what can be done to protect yourself and those you love? our cohost, rajahad ali, there's tons of it, and everybody is interested in this, and if you're talking about yourself or parties or grandparents. >> you mentioned that 70% of americans are taking at least one drug, and it's causing a lot of ailments, and who is respondent? the community tweeted in:

so the community agrees there's a problem, so who is to blame and what can be done about it. >> to help us get a handle on it, dr. carom, a group that advocates on behalf of consumers. professor david lee joins us, one of the authors of that ground breaking study on drug interaction. peter pitts worked with the fda for many years, and now he's in a healthcare non-profit. and dr. caleb alexander, the codirector of john hopkins center for drug effectiveness.

so professor lee, this study, your folks did in corroboration with those at yale. and it really gets your attention. how did we get to a place where one in five older adults are in a place where drugs are working against each other? >> i think what we do is treat one condition at a time. and we need to treat the whole patient, as we get older when we have multiple medications and multiple problems, and we need to treat these as a whole. and currently, we have too many specialty physician organizations that will recommend a lot of medications for each condition, and when those add up, that's where the problem ends up. the crum, how common are these medications? >> these medicines are commonly used and having people on multiple medications at the same time is common.

particularly when adults are 65 and older. the average prescriptions is 23. >> 23 different prescriptions per person. >> per year. >> after 65. >> on average. and you can imagine with that many drugs being prescribed, plus over the counter medications, the possibility is high. and every year, we have almost 1 and a half million hospitalized, and 100,000 deaths per year, so this is a very very serious health problem. >> dr. alexander, any chance that the more the risk goes up and the drugs you're on, the more likely an adverse effect? >> well, there's no question that as the number of medicines increases, the potential for disease interactions and drug interactions increases

exponentially. when you realize that one-third of seniors are on five or more, when you consider all of the combinations of drug interactions or drug-disease interactions we're talking about substantial numbers. >> 100,000 drugs occur every year due to adverse drug reactions, and how do we alleviate this? >> peter, i want to get new the conversation, and ultimately whose responsibility is it. >> it's a team effort.

the patient has to be educated. but that can't be placed squarely on the physician and the nurses in the physician's office. pharmacist plays a key role. and that's brick and mortar pharmacies, and you lose the opportunity for a brick and mortar pharmacist to do what they're trained to do, which are pharmaceutical audits, to make sure that no patient is getting megses that work at odds with one another. so the pharmacist has to be an integral part. >> dr. crum, is an adverse reaction often prescribed for the problem, and then another drug? >> someone gets prescription a and then they manifestims of another disease, and it looks like parkinson's disease, and if the diagnoses is mixed, and

rather than the drug that causes the symptoms, the patient is put on at i parkinson's drugs, and those may cause side effects and interact with other drugs that the patient is on. so that's a problem when that are occurs. >> professor lee -- >> a lot of times, just to get a point here, when a patient is initially prescribed a drug for a condition, doctors and researchers back this up, they really do not spend enough time explaining to the patient how the pill should be taken, when it should be taken, how it should not being b be taken, and specifically, when things go wrong, pick up the phone and call the doctor's office right away. >> professor lee, you don't want to say that doctors are being negligent. this is an overburdened system. and they are taking more

patients to make up the distance, and so where is the disconnect here. >> as peter mensed, we need a team approach. and let me advocate for pharmacy. because i teach in a college of pharmacy and i'm a pharmacist myself. is the team approach what we want to have for our patients? especially as we get older, you need a pharmacist onboard as a team member, but i can't stress enough, the patient themselves need to express their values more forcefully. if they don't want to take a medication or they think that the new medication is causing a problem, they need to speak up. >> hang on. professor lee. i had this experience with my own parents. they come from a generation where they put so much trust in the raul of that certificate that hangs on the wall that says md. that they don't challenge their doctors, it's not in them to say what about this? what about that? how do you get over the hump with this aged generation that

has put these physicians on a pedestal. >> oh, i completely agree. and what we have to do is start training our patients to be more sceptical and value their own opinions as part of the team. >> we have a great story, it's a sad one: dr. alexander, i want to get you in the conversation, what are the most frequent drug interactions affecting americans today some. >> i just want to make one point. i think that this study provides very important -- sheds important light on the issue, but the study wasn't designed to determine precisely in one in five cases if the drugs were not mid correctly or not, and i think that many patients recognize that it's science and medicine.

so i think that the study is terribly important. because it's facilitating and prompting conversations like the one we're having, but i think it's important to also emphasize that in many cases, the clinicians make reasonable judgments with patients, and a shared decision-making model, trying to navigate a number of competing demands, so by no means should one interpret the study suggesting that 20% of medicines that seniors are on are inappropriate or are going to hurt them because of the chronic conditions that they have. now, you have to question about which medicines are most and in many cases, it's the ones taken. an inhibiter used for arthritis may increase the threat of heart attacks or strokes, and prednisone, an oral steroid, which can be life saving for

patients with severe asthma, it can increase the risk of diabetes or gastric ulcers, so in many cases, we're talking about hyper tenses, and messes that americans are on. >> when you're talking about in older generation of patients, are there age related changes in the body that affect how the drugs are metabolized and processed that can play into this? >> absolutely. there are multiple physiological changes that occur as we get older. in particular, our kidney function begins to decline. you max out and over the years, you lose kidney function, and many drugs are eliminated by the kidneys, so as you get older, you need to adjust the dose downward, and if you don't do that, you put the patient

adversely. >> so they're not cleared out as fast? >> there are drugs that are metabolized by the liver. >> coming up, there's a belief in america, that there's a pill to fix whatever ails you. so many rush to the doctor to look for an instant fix. but are we better off with fewer meds? we're going to tackle that right after the break.

>> welcome back, we're talking about an important new study that says one in five older americans that says one in five older americans take prescription that's work against you. my husband and i laugh about it because the disclaimer is longer than the product. has america caplized on the instant gratification and caused you us to think there's a

medicine to fix everything. >> i think it's our culture to think there's a magic pill. when we exercise and drink more water and all of the things that mother said are good for us, but we have evolved into a syndrome where a problem happens, and we want an instant solution, whether it's financial or medical. and there are so many innovagues that people think there's a cure for everything, and while medications, also safe, have risks and that's a balance that needs to be discussed with a physician. so we want it to be true, but i think it's the responsibility of the fda and pharmaceutical companies and healthcare professionals and the media to set the record straight. >> latino politics, it's bizarre to think that each back in the 90s, there were not as many farm commercials and now thia bound. and speaking of that, 70% of

americans are on a prescription pill. i'm sure that there's a farmer saying what? why is it only 70%? and then we have a video comment from elizabeth. >> my mother was given a sample of a new medication and had a stroke the next day. the neurologist diagnosed her stroke as being specifically to the drug interaction with this new drug with her other medications. conversely my doctor only uses samples to help patients who might not be able to afford new medications in the marketplace. i'm concerned that this is a marketing problem. how do we alleviate that? >> joining us now is dr. natalie bowler, a hosting physician who focuses on treatments. and dr. bowler, you heard elizabeth's question. >> i think that. people look to diagnoses

themselves based on what they see on fev, and tv, and it's it for people to look at what may be their healthcare needs based solely on what they are possibly missing from from their nutrition and lifestyle habits, and not just what they see on tv. >> an important point to clarify is that when it comes to advertising, the fda has done numerous research studies that show that even though a patient may ask for a drug by name, if the patient doesn't have the condition that drug treats, the drug is not prescribed, and though a powerful marketing technique if the patient has the condition, inappropriate prescribing is not going on. >> i disagree with matt. two major problems that describe our prescribing in this country are the direct consumer promotion that are occurs, and we're only one of two countries that allow the direct consumer

advertising that you see on television. that's a problem, it influences the patient's behavior and the expectations. let me give you an example. testosterone drugs for hyper gotten addism in men, which is an uncommon condition, and it's approved for those disorders, and those drugs for testosterone are being taken by millions of men who don't have hypogonadism. and they're being checked before going on the drugs, and many are not having their testosterone level checked. and you can't be diagnosed with that without a blood test, so there are patients going out there because of the advertising that durs directly to them. >> dr. alexander, you want to weigh in on this?

it picked up in the late 90s, and there are vocal advocates for it, and opponents for it. and it's a vexing issue. it's something that opponents argue, just as some of what we have heard, as overprescribing. it's concentrated. two-thirds of it occurs for just about 20 medicines on the market, and there are several thousands, and direct advertising only detects for 15% of promotion. so while it's a lightning rod for controversial, it's pretty mild compared with the much more common detailing and free samples that occurs in the physician practicing. >> and a second factor, the promotions for physicians that

contact between the pharmaceutical industry and the physicians, and that clearly is another major driver of overprescribing, and we know that many many drug deputies have been found guilty of criminal and civil of violations of the law, many times leading to misleading promotion to promoting for off-label uses, which is clearly illegal and inappropriate prescribing behavior. >> well, doctor -- >> what it does, to get in here, it drives people to see their doctor, and many visits that are prompted by consumer advertisement in a previously undiagnosed condition is diagnosed. so the generation of people visiting their doctors to discuss their own health is incredibly important. and it adds to the benefit of that interaction. >> and i wonder, dr. caron, dr. alexander mentions that there are only 20 medications that are heavily advertised. but they're for of the most

common ailments, like heart disease and diabetes with these dangerous interactions and is that the case? the medications for the most common illnesses? >> it is. you see one of the newer diabetes medications, that we advise people not to use. and that's a drug prom odd television, and it's a drug for commondies, and then this low t syndrome, reported on sports shows and news shows. every night i see commercials for that. and many of the people getting the drug do not have the disease or the disorder for which the disease is approved for. >> 80% of the drugs that are sold in this country are generic drugs for largely cardio vascular diseases that are not advertised so i would disagree that they are.

and that's not true. >> this one just came in: >> coming up, america is fend ant on its meds, and would we be happier with less pharmaceutical?

>> welcome back, we're talking about the negative drug interactions that occur when people are taking several drug prescriptions, and especially in older americans. and it's not just to the cost of our health but the whole

industry. dr., you said that the entire system is struggling, and what are the obvious costs of too many meds? >> i think that first and foremost patients struggle because millions of americas are burdened by their out of pocket costs, and often patients are faced with difficult decisions, skipping or stretching medicines, so the direct costs of the drugs themselves, the costs to the insurance plans that ultimately we have to pick upickup bills and are financed y patients, and them when you're talking about an adverse event lake lie heart attack or a stroke or other maim convenient, it can cost tens or hundreds of thousands of dollars that are shouldered by the general public and accounter our whopping healthcare bill in this country.

we're talking about alternatives for medicine: so speak about that, dr. bowler. >> i think one of the challenge was naturopathy is this is truly a profession that blends a lot of our african/eastern medical traditions which are really related to pharmacology, and which are about a mind-body-spirit connection, and oftentimes when it comes to our medical system, there's not enough time in the day for our doctors to interface patients in a real way. >> what are the benefits to getting off the chemicals? >> i think that the first one,

absolutely quality of life. i think many patients who are living with these challenges and conditions really are sometimes complaining of fatigue, and just not feeling like themselves, and often times, it's exciting to watch a person go through a healthy transition and begin to feel like themselves again. >> dr. cronen, what are suggestions that you have for your patients? i'm you're that there are a lot of people out there right now, thinking holy cow, i have all of these meds in my cabinet. >> just a word of caution, now, based on what you hear here stop taking your medication because a lot of medications are important. you should have a brown bag session with your doctor. gather all of the medications from your medicine cabinet. including the over-the-counter medications and review all of the medicines that you're on. and that should be done at least

annually to make sure that you're not on drugs that are conflict in a harmful way and to make sure that everything that you're on, you need to be on. to make sure that the doctor knows that the specialist put on you two other things to be aware. a brown bag session with all of your medicines. >> i would also in that same session, with your doctor of integrated medicine. far too often our patients don't bring up their hersalls into those, it's important that you the consumer know the acupuncture or what the cranial sake ral therapist put you o. that you bring someone who is a specialist in the field to assist you. >> that brings us to what everybody says, you have to be your own best advocate and take

the first step and be out spoken about your medical care. thank you to all of our guests. see you next time. >> good evening, every. welcome to aljazeera america. i'm johnson cit recall, regret,s from general motors ceo for a decade of safety defects. lawmakers tell her people died of the failure to communicate. outbreak, the dangerous ebola virus spreading through west africa,