Jewish Home researcher wins national stimulus grant

Nearly 20,000 researchers applied for a National Institutes of Health challenge grant funded through the American Recovery and Reinvestment Act.

When the grants were awarded Sept. 30, only about 4 percent of the applicants were winners — including the research director at the Jewish Home in San Francisco.

Dr. Janice Schwartz

“It’s astonishing,” said Dr. Jay Luxenberg, medical director at the Jewish Home. “When you consider how few grants were offered in the whole country … it’s amazing that a little Jewish nursing home got one.”

Nationally, 840 grants for health and science research were awarded, and, aside from the Jewish Home, all 112 recipients in California were universities, hospitals and research labs.

Dr. Janice Schwartz, the Jewish Home’s research director and clinical professor of medicine and pharmaceutical sciences at UCSF, was awarded $900,000 over two years to study how multiple medications affect elderly Americans who suffer from multiple diseases, and how to improve their treatments.

Her field of focus, polypharmacy, looks at the concurrent use of multiple medications by an individual, and the ways in which drugs can interact to cause side effects even worse than the ailments or diseases they were intended to treat.

Schwartz will comb through existing data from nursing homes and the Veterans Administration, collected over the past several years from more than 2 million people older than 65.

She will undertake the two-year study with her colleague, Dr. Michael Steinman, a geriatrics physician and professor at UCSF and the husband of Berkeley Hillel Rabbi Dorothy Richman.

Ultimately, Schwartz and Steinman want to learn how to adjust doses and numbers of medications for older patients to avoid side effects, so physicians can “treat an individual patient — instead of an individual disease,” Schwartz said.

Currently, doctors usually prescribe medicine to a patient for each disease. For example, a doctor treating a 70-year-old man for hypertension, coronary disease, prostate cancer and arthritis likely will prescribe medicine for each condition.

Dr. Michael Steinman

“A doctor faced with someone who has five diseases might end up with a patient taking 11 or 12 medications a day,” Schwartz explained.

And the more medications an individual takes, the more likely he or she will experience harmful drug interactions, Schwartz said.

Complicating matters is that adults over 65 are more susceptible to adverse drug interactions simply because their physiology changes as they age. The heart pumps blood less efficiently, the liver breaks down drugs more slowly and kidneys struggle to excrete the drugs. These changes mean that the way an elderly person digests, absorbs and excretes drugs is different from a younger adult.

And yet no medical studies have focused exclusively on how the elderly take and are affected by multiple medications, according to Schwartz.

Such a study is important, she said, given that the average nursing home patient receives nine drugs per day.

“We want to come up with what we think would be the best care for the most common combinations of diseases,” Schwartz said. “We want to know: What is the best medicine for a person who has three illnesses, instead of treating each one separately?”

The nation’s elderly consume about 40 percent of prescribed drugs according to a 2007 study published in Emergency Medicine Magazine.

Also, up to one-third of all hospital admissions are due to adverse drug reactions, the study reported. Many of those people die. In fact, fatal drug reactions would be the fifth-leading cause of death in the United States if they were classified as a distinct category, the study noted.

“It’s a giant problem,” Luxenberg said. “The better science becomes, the stronger our medicines are, and the more likely they are to cause dangerous side effects.”

Schwartz has studied how to improve medication therapy in older adults for 25 years. The NIH has funded her research since 1985.

Once she and Steinman determine the most common combinations of illnesses, they will develop an algorithm that will result in fewer medications prescribed and fewer unwanted side effects.

The doctors hope this work will lead to a later study comparing the effectiveness of this approach with “usual” medication therapy.

Yet their research will never be entirely complete.

“There will always be more to do, because there will always be new medications and new interactions,” Schwartz said.

Because of the ever-changing state of medical research, Schwartz and Steinman do not intend to provide physicians with specific treatment guidelines.

Instead, they hope to “present a new way of thinking, a new paradigm” as opposed to rigid guidelines, Schwartz said. Their goal is to encourage doctors to think about a patient’s illnesses collectively, instead of individually, in order to come up with new and improved treatment plans.

Stacey Palevsky