Robert N. Butler, M.D., renowned gerontologist, will examine the hazardous problem of ageism in America's health care system and the under representation of older persons in clinical trials during his testimony for the Senate Special Committee on Aging May 19 hearing on "Ageism in the Health Care System: Short Shrifting Seniors?".
The Committee, headed by Senator Larry E. Craig (R-ID), chair, and Senator John Breaux (D-LA), ranking member, will hold the hearing at 2 p.m. in Room 628 of the Dirksen Senate Office Building to explore the ways in which ageism in our nation's health care system is negatively affecting the quality of care for older Americans.
"People aged 65 and over are woefully under represented in or even excluded from these trials, despite the fact that they are the ones who generally take the most medications. The result is a lack of understanding of how drugs and treatments will work in older persons, which can lead to adverse reactions and inappropriate dosages or treatments, and the misperception that older people cannot tolerate or benefit from new drugs and procedures," Dr. Butler states in his testimony. "The current situation is reflective of ageism in the health care system and is unacceptable."
Dr. Butler, president and CEO of the International Longevity Center-USA (ILC-USA), first coined the term "ageism" in 1968 when he was chairman of the Washington D.C. Advisory Committee on Aging.
He cites three recent studies that document the under representation of older persons in clinical trials. According to the studies, only 25 percent of people participating in clinical trials for cancer treatments were over 65, although this population accounts for over 60 percent of all cancer cases. Women over 65 make up nearly half of all breast cancer cases but only 9 percent of those involved in breast cancer treatment trials were of this age group.
Clinical trials for heart disease treatments found a nearly identical rate for participation among older people. Only 9 percent of patients enrolled in these trials were 75 and over, although almost 40 percent of people who suffer heart attacks are in this group. "So, we really don't know the effectiveness of all these new cholesterol-reducing drugs on older people," Dr. Butler states in his testimony.
He also points out recent studies also found medication problems may be responsible for as much as 17 percent of hospitalizations of older Americans. Another study says this situation also costs approximately $20 billion a year in hospital stays.
In his testimony, he proposes the creation of a national clinical trials and evaluation center made up of several regional centers around the nation, perhaps similar to how the current Department of Health and Human Services is organized into 10 different regions. This would provide several benefits including, "a more efficient, cost-effective, centralized approach with consistent standards, benefiting all parties involved."
He lays out several more ideas for congress to consider, including enacting legislation to encourage better representation of older people in clinical trials, much like what was done for women and minorities, looking at legislative opportunities like those in place for pediatric studies to motivate drug makers to test products on older people and exposing all physicians to the field of geriatrics during medical school.
"In order to ensure that older people receive appropriate, evidence-based medical care, it is critical that they be better represented in clinical trials of drugs and treatments," Dr. Butler states in his testimony. "The simple fact is that all drugs need to be tested in all populations that might be taking the drugs."
The ILC-USA published issue brief entitled "Clinical Trials and Older Persons: The Need for Greater Representation," is the basis of for much of his testimony. You can obtain a copy by calling the ILC-USA communications department at 212-606-3383 or downloading it from www.ilcusa.org.
The International Longevity Center-USA is a not-for-profit, nonpartisan research, policy and education organization whose mission is to help societies address the issues of population aging and longevity in positive and constructive ways and to highlight older people's productivity and contributions to their families and to society as a whole. The ILC-USA is an independent affiliate of Mount Sinai School of Medicine and is incorporated as a tax-exempt 501(c)(3) entity.
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