Polypharmacy dangers

Polypharmacy means taking several medicines regularly, usually four or more. A recent issue of the Journal of the American Medical Association noted, “Between 2015 and 2025, approximately 63 serious adverse events attributed to drug-drug interactions were reported to the US Food and Drug Administration among adults aged 65 years or older, 10% of which were fatal.” (Older people have slower drug metabolism and more chronic conditions, plus they see more specialists prescribing medications and use more OTC drugs and supplements.)

Here are the drug combinations rated the most dangerous:

• Blood thinners, such as Warfarin, taken with NSAIDs (non-steroidal anti-inflammatories, such as Aspirin and Advil), can dramatically increase the risk of internal bleeding.
• Blood pressure medications, such as Lisinopril, taken with diuretics, such as hydrochlorothiazide, plus NSAIDs, is a “triple whammy” that can cause acute kidney injury.
• Opioids, such as tramadol, taken with Benzodiazepines, such as lorazepam, can slow breathing and cause respiratory depression, confusion, falls, and overdose.
•  Antidepressants, such as Zoloft, taken with supplements, such as St. John’s Wort, can trigger serotonin syndrome—a buildup of serotonin, the symptoms of which can be mild  (shivering and diarrhea) to severe (muscle rigidity, fever and seizures), to death.
• Statins, such as Lipitor, taken with certain antibiotics, such as erythromycin, can cause muscle breakdown and kidney damage.
• Diabetes medications, such as insulin, taken with beta-blockers, such as metoprolol, can hide symptoms of low blood sugar, making hypoglycemia harder to detect.
• Anticholinergics, such as Benadryl, taken with sedatives, such as sleep aids, can increase the risk of confusion, falls, memory problems, and delirium.
• Multiple OTC cold and flu products taken together can cause liver damage. Examples of risky combinations include NyQuil plus Tylenol; DayQuil plus cough syrup; anything containing acetaminophen.

The intended audience for this article is doctors. I would have hoped that they already knew about these interactions.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Tacit knowledge

 A new startup company is trying to discover the hidden factors that make some scientific experiments succeed and others fail.  For example, one lab succeeded in detecting the Covid virus, but another, using the same protocols, failed.  

To determine how this happens, the company’s researchers are closely monitoring scientists as they work. Cameras capture their every move, and the scientists narrate their work into microphones. Artificial intelligence adds to the narrative with explanations such as “The operator resuspends the pellet by pipetting it up and down ten times.”  The idea is to capture science as it happens in such a way that artificial intelligence models can be trained to recognize every object the scientists used and every action they performed.

When scientists carry out experiments, they keep careful records in their lab notebooks. Subsequent researchers use those records to repeat the experiment. Sometimes the repeated experiment doesn’t work. That’s because not every detail got written down.

Scientists make thousands of minor decisions over the course of a day, such as how they shake a test tube. Such decisions are based on “tacit knowledge": the practical know-how, skills, and intuition that are difficult to write down, explain, or teach to others. Some researchers consistently get experiments to work, but they don’t know why. According to their colleagues, they have magic hands.

In reviewing the lab scientists’ audio and video records, researchers are finding that the workers are performing the same experiment in many different ways. As one analyst noted, “The variation we see even among well-trained scientists is pretty jaw-dropping.”

The researchers are going to have to sift through all this information in hopes of finding the secrets of success. Who knows? Maybe AI can figure it out.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Genes and personalities

According to some new studies, certain personality traits are linked to our genetic makeup. Those traits include extroversion, agreeableness, conscientiousness, neuroticism, and openness to experience.

To reach their conclusions, researchers analyzed more than a million genomes and ten million variants, looking for the variants associated with personality types. (A genetic variant is a permanent change or difference in the DNA sequence that helps make us unique.)

The researchers found, for example, that a high extroversion profile seemed to reduce a person’s risk of anxiety, depression and post-traumatic stress disorder, presumably because people with that profile are less likely to internalize their distress and more likely to share it with others. Neuroticism, which is defined as a tendency toward emotional instability, was correlated with 10 different psychiatric disorders, plus a higher body mass index and increased rates of smoking.

Your DNA and your experiences interact to mold the person you become. You and your siblings may have grown up in the same household environment, but, because of different DNA, your personalities are also likely to be different.

I went to the 23andMe website to see if my personality traits might be listed. They’re not, although I did see that there’s 93 percent chance that I’ve never had dandruff and a 71 percent chance that I don’t have stretch marks. Both are true. Maybe in a few years they’ll list my personality traits, although I’ve pretty much figured those out for myself.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Orthosomnia (preoccupation about sleep)

Most nights I wake up around one or two in the morning and lie there—sometimes for an hour or more—before going back to sleep. I’d rather my sleep wasn’t broken, but I don’t worry about it. At times, during these wakeful periods, I’ve solved problems and come up with good ideas. I never get eight hours. It’s usually between six and seven.

One primary care physician writes that “good sleep, or the lack thereof, is one of the most evergreen concerns I hear about as a primary care doctor. My patients track sleep hours and sleep scores.” Apparently, there’s a new, unhealthy, preoccupation with achieving perfect sleep that’s driven by wearable sleep-tracking devices. This obsession is called orthosomnia.

Here’s what studies show about the relationship between sleep patterns, health, and mortality:

• There’s not a magic number below which health suddenly falls off a cliff.
• In studies that compare sleep duration and mortality, the lowest risk clusters around seven hours.
• Adults with the highest mortality rates are those who sleep nine to 11 hours a night. (People who are sick sleep more. So do those who are struggling with depression.)
• Getting less sleep is strongly correlated with living in poverty, working a job that requires night shifts, psychiatric conditions, and chronic pain and illness.

The hunter-gatherer Hazda people of Tanzania sleep an average of 6.25 hours per night, although they’re in bed for up to nine hours. During that time, they’re awake for two or more hours. My kind of people!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.