Dr. Demetra Antimisiaris is an Associate Professor at the U of Louisville School of Medicine, and Director of the U of L Frazier Polypharmacy and Medication Management Program, an endowed program dedicated to understanding and fighting the problem of polypharmacy. Polypharmacy has been considered a geriatric syndrome (geri-syndromes are problems common to aging caused by multiple factors as opposed to a single organic disease, examples of geri-syndromes include falls and cognitive impairment, which are not normal aging but common due to many factors, including inappropriate medication use). But today, polypharmacy is no longer just the domain of older adults, as per capita medication use burden is increasing every year in all age groups, including children.
Dr. Dee earned her Doctor of Pharmacy degree at the University of the Pacific in 1989, and completed a VAMC-UCLA lead clinical geriatric pharmacy residency in 1990. The VAMC-UCLA program was innovative at the time for studying polypharmacy. From that program came the “Beers Criteria” for potentially inappropriate medications in the elderly, written by the late Mark Beers, MD, also a graduate of that program. The problem of polypharmacy continues to be a poorly understood phenomenon and the U of L Polypharmacy and Medication Management Program is dedicated to education, research and collaboration regarding polypharmacy.
Note that the UCLA program I went through was seed funded by the Reynolds (Donald Reynolds of Oklahoma) Foundation, a philanthropic foundation dedicated to helping the problems of the aging, and from that came an area of study that no pharma company or NIH grant at the time was interested in funding aging study- where’s the money in that, especially in the 70’s when elders overwhelmingly were not wealthy. Likewise, the Frazier PMMP, is a unique program amongst US medical schools because the typical mechanisms that fund and influence medical education and research would not fund this sort of work.
Much of the academic funding was and is not, geared towards studying aging which in turn influences the guidelines which we are made to adhere to. The guidelines are geared to implementing more interventions based on large cohort studies also called evidence based medicine, because Pharma funds and influenced NIH funding of study grants and policy. (that said: just recently the government and insurers, or payers, realize now, as many governments and payers, around the world are realizing, that the aging population is a huge financial threat to all, think of the burden of Alzheimer’s coming down the pike, so now they care to fund more NIH research on aging-with regard to saving money on elder care ideally through identification of what constitutes quality outcomes. Problem is, as we age we diverge from each other physiologically and in our mix of problems, making population based studies of treatment of the complex multimorbid patient very difficult.) The gold standard, the randomized controlled trial means you take two equal groups of people and implement one intervention to look for differences in outcomes. Tough to get two equal groups with elders. So funding the study of polypharmacy interventions is not common. This is why it is a privilege to direct the Frazier Polypharmacy and Medication Management Program- being a good steward of this private (wealthy) philanthropist’s initiative is why I work here (heck, who would leave the island of Hawaii and Pasadena Cali, my family homesteads for 4 generations otherwise?).
Professional Stuff: Dr. Demetra Antimisiaris, Dr. Dee, is an Associate Professor at the University Of Louisville School Of Medicine and leads the U of L Frazier Polypharmacy and Medication Management Program. This is an endowed program, supported by a private citizen and unique amongst medical schools in the United States (or elsewhere), dedicated to help fight the growing problem of polypharmacy.
NEW: After working for ten years within academia to develop and disseminate research, education, and clinical skills training on polypharmacy and medication management, Dr. Dee is taking the effort extramurally by creating a non-profit association of stake holders touched by polypharmacy. The soon to be launched “American Polypharmacy Society” will provide a means to include the majority of concerned stake holders in the effort towards more rational medication use.
Within academia, education and research fail to connect those impacted by our unprecedented high drug use burden such as: law enforcement, employers, workers, families, students, athletes, departed celebrities (the moment prince died I knew why!), military, state and local government, and so many more. Kentucky is ground zero for scripts per capita in the United States as well as ground zero for opioid abuse in the United States, and the United States is ground zero for consumption of pharmaceuticals.
Just Dr. Dee Stuff: (Dr. Dee) I started out on a mission to pass on the skills that were passed down by the generation past, and to contribute my little part to human excellence and the future. Why else would someone go into academics?
This lead to the awareness that there is a race to the bottom ongoing in which the ubiquitous extraction of value by individuals devoid of an equal contribution of value, will soon rob us and future generations of excellence and American exceptionalism.
Coming to academia from the private sector 10 years ago (I am not a government employee, I am an endowed chair- there’s a difference), the inefficiency of the educational system, healthcare system, and academic framework, was so blatant that to reach my program’s goals, I had to look for ways around the barriers. My common method of work around is ensuring the contribution of value at every step (who you hire, what you engage in, and so on).
Connecting the dots, extraction of value without producing value is a current related theme throughout politics; nature, cultural conflicts, societal conflicts, and the reason for the election results are systems all around that take out value without adding any back and results in chaos and a race to the bottom.
It is impossible to run a small business by taking value (paycheck) without generating some value (sales).
It is also the 2nd law of thermal dynamics. Namely, random interactions will eventually lead to great disorder, or the old, you can’t unscramble an egg. Essentially this law says that there are microscopic so to speak, interactions of chaos or randomness that lead any system over time to become more disordered.
This means, we have to put energy into having order in everyday life and everything we do to avoid “scrambling the egg”. Each person has to do their part to create order and stability or else there is no means to unscramble the ensuing disorder.
It’s tough to have order when the educational system have successfully dumbed down our ability to critically think, to understand history, remove cultural and religious framework, and extract wisdom in trade for resources, time and energy, dedicated more to “social justice” than the ability to add, multiply, write and read. Today’s students live in a literal matrix-they don’t know what they don’t know.
Lastly, it is a constant theme in Christianity. The theme of not taking for yourself (extracting value) but rather providing value (putting the work into your day and your community) is everywhere.
We are to defend those who cannot speak for themselves (proverbs 31:8-9)…not the loudmouths who demand cellphones and such.
Do what is good because of God’s grace (Titus: 1-7)… strive to be good because that’s what you’re SUPPOSED to do- not a satanic worshiper.
Love God before self and others (Matthew 22:36-40)….note the before self-part especially.
When I was a kid, a priest said to me “Every time you go out your front door, you are putting on armor and going to war against the evil one”- I think this is an accurate description for the time being. We are going to experience birthing pains trying to restore order to this bankrupt system, but good will win. (Orthodox Christian priest, not catholic, just saying)
Favorite music group: Kraftwerk,
Am a vegetarian (fish too) but not a militant vegetarian, don’t care what anyone else eats!