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Stories for Reprint
Age Matters When Prescribing Drugs
By Ferdous Al-Faruque, MARRTC Staff
If you have rheumatoid arthritis, your age might sway what your rheumatologist prescribes for you. A new study conducted by Yale University found that rheumatologists, doctors who specialize in treating arthritic diseases, are more willing to prescribe aggressive drug treatment for a younger patient than an older one.
Yale researchers mailed questionnaires to nearly 500 rheumatologists around the country about two hypothetical patients with rheumatoid arthritis or RA. The patients were identical in every way except one was older than the other. The rheumatologists had several options of treatment ranging from mild to aggressive drug therapy. Of the 204 rheumatologists who responded, 8 out of 10 physicians preferred aggressive drug therapy over drugs that would be less potent and less toxic, but might be less effective. However, they were also more likely to give less aggressive treatment to an older RA patient.
Michael Lockshin, a rheumatologist with the Hospital for Special Surgery in New York and editor-in-chief of Arthritis and Rheumatism, the leading arthritis journal, says that treating people based on age is and should be the norm. As people age, their bodies cope with drugs differently. He says that this is especially true with certain drugs such as immunosuppressants, which are often prescribed for RA to suppress the body's immune system from attacking their joints. "Older people don't handle immunosuppressant drugs as well as younger people," says Lockshin. "Older people have more infections." Though such drugs can help older people cope with their RA, at the same time it makes it more difficult for them to fight off an infection.
The study also found the physician's gender and the years in practice also correlated to aggressive drug treatment for the patient. The physicians most likely to prescribe a more aggressive treatment for their patient were usually women or physicians with fewer years in practice. Lockshin says that it's interesting to see a how gender and years of practice also play a role in treatment. Though he doesn't have an explanation why that is the case, he suggests that gender and years in practice may be linked. "Female rheumatologists tend to be younger than male rheumatologists," says Lockshin. He says experience physicians gain over the years prescribing drugs and seeing their patient's reaction to those drugs may explain why rheumatologists with more experience are also more hesitant to give stronger drugs to their older patients.
Lockshin says that this kind of research is especially important for the medical community. "From my point of view for physicians to be conscious of how they assess treatment is very important," he says. He adds that awareness of their own biases and how they may impact patients can make them better physicians.
Besides what physicians can learn, Lockshin says there are also lessons that patients can take away from this research. "Patients have to be their own advocates," he says. He adds patients need to realize physicians may have their own biases and that they have the right to ask their doctors about their options, if their needs are not being met.
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