Show 1447: Falls, Fractures and Fatalities: Surprising Risks in Your Medicine Cabinet

This week, we start the show with an interview with epidemiologist Thomas Farley, MD, MPH. His essay in JAMA Health Forum (Aug. 8, 2025) describes why older Americans are dying of falls at an alarming rate.  Once you have a chance to hear why this problem is worse in the US than in comparable countries, we will welcome your calls and stories. Prescriptions for medicines that make people drowsy or unsteady play a major role. Are you taking any? You can call in between 7 and 8 am EDT on Saturday, October 4, 2025, at 888-472-3366.

At The People’s Pharmacy, we strive to bring you up‑to‑date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

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You could listen through your local public radio station or get the live stream at 7 am EDT on your computer or smart phone (wunc.org). Here is a link so you can find which stations carry our broadcast. If you can’t listen to the broadcast, you may wish to hear the podcast later. You can subscribe through your favorite podcast provider, download the mp3 using the link at the bottom of the page, or listen to the stream on this post starting on October 6, 2025.

The Epidemic of Deaths from Falls:

Dr. Thomas Farley wrote in JAMA Health Forum that falls kill more Americans over 65 than breast or prostate cancer. If you add up deaths due to car crashes, overdoses and other unintentional injuries in older people, the total is still below the number of deaths from falls. That toll was more than 41,000 in 2023. It has tripled over the past three decades.

Why are elderly Americans (particularly those 85 and older) so much more vulnerable to dying because of a fall? Perhaps older people everywhere suffer the same fate. Dr. Farley considered that as a possible explanation. But in other high-income countries that might serve for comparison, the rate of deaths from falls has actually dropped over the past 30 years.

One difference that might help us understand what is going on is the rate of prescriptions. After all, older people have always contended with vision problems, physical frailty, cognitive impairment or clutter that is a trip hazard. Those things probably haven’t changed much since the year 2000. Today, though, older people are taking more medications. Older Americans take far more than those living elsewhere.

Which Drugs Increase the Risk of Falls?

Not all drugs increase the risk for falls. From 2017 to 2020, Dr. Farley points out, 90% of seniors were taking prescription meds, and 45% were taking drugs considered “potentially inappropriate.” Many of those could be termed Fall-Risk Increasing Drugs, or FRIDs. Are you taking any?

Any medicine that interferes with balance or causes drowsiness is probably a FRID. Dr. Farley points to four categories in particular: opioids to treat pain, benzodiazepines for anxiety, antidepressants and gabapentinoids used off label to treat pain. (These are gabapentin, aka Neurontin, and pregabalin, known by the brand name Lyrica.) Other medicines, such as beta-blockers for heart conditions or anticholinergic drugs like diphenhydramine, can also cause problems. The overwhelming majority of older folks injured during a fall were taking one or more FRID at the time.

Some of the medicines we are discussing are also covered by the American Geriatrics Society Beers Criteria for potentially inappropriate medication use in older adults.  Any prescriber caring for people over 65 should be able to check whether the drug they are contemplating is on the Beers list. They may also want to consider whether there might be a less risky alternative. If you are accompanying an older relative, you could ask about that. Occasionally older patients are reticent about asking questions for fear of offending the prescriber.

Beyond the Usual Suspects:

It is hardly surprising that opioids would be related to a risk of falls. There are, however, other medicines that might be a problem in some circumstances. Blood pressure pills may cause dizziness, especially when a person first stands up. Certainly high blood pressure needs to be treated, but perhaps patients should consider trade-offs in terms of how aggressively to pursue perfect blood pressure numbers. Another medication that has been associated with falls, surprisingly, is the combination of atorvastatin to lower cholesterol and insulin for diabetes (Gerontology, Sep. 2, 2025).

Call in Your Questions About FRIDs:

Listen to Dr. Farley describe the problem. Then we welcome your calls. Have you taken a medicine that makes you drowsy or unsteady? Have you or an older relative taken a tumble you suspect was related to a medication? We want to hear about it.

We spoke earlier with Dr. Farley. After we listen to his interview, Joe and Terry will try to answer your questions about medicines that might increase the risk for falls. Are there alternatives? What can you do? The show airs live from 7 to 8 am EDT on Saturday, Oct. 4, 2025. Give us a call to ask a question or share a story: 888-472-3366

This Week’s Guest:

Thomas A. Farley, MD, MPH, has been a public health educator, researcher, and practitioner for more than three decades. Dr. Farley is a Professor of community health at Tulane University and has held positions in health agencies at the federal, state, and big city level. He is the author of Prescription for a Healthy Nation, Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives, and Prevention of Diseases in Populations: From Biology to Policy.

Dr. Farley writes a newsletter on Substack called Healthscaping.

https://medium.com/@DrTomFarley/about

The People’s Pharmacy is reader supported. When you buy through links in this post, we may earn a small affiliate commission (at no cost to you).

Thomas A. Farley, MD, MPH

Listen to the Podcast:

The podcast of this program will be available Monday, Oct. 6, 2025, after broadcast on Oct. 4. You can stream the show from this site and download the podcast for free.

Download the mp3, or listen to the podcast on Apple Podcasts or Spotify.

Transcript for Show 1447:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material. All rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:05-00:27

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com. Falls send a lot of people to the ER. In fact, more older Americans die from falls than from breast or prostate cancer. This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:35-00:44

The number of deaths from falls in the U.S. has been increasing dramatically in recent decades. That’s not true of other developed countries. What makes us so vulnerable?

Joe

00:45-00:53

Our guest today blames overuse of prescription drugs. Many of the pills Americans take make them unsteady on their feet.

Terry

00:53-01:01

Has your medicine ever made you dizzy? Our lines are open for your stories and questions at 888-472-3366.

Joe

01:01-01:07

Coming up on The People’s Pharmacy, the surprising risks in your medicine cabinet.

Terry

01:15-02:26

In The People’s Pharmacy health headlines. When COVID first appeared, one of the novel symptoms that people reported was a loss of the ability to smell. Now research indicates that this problem can last for years. The study, called RECOVER, included 1,393 people who said they had trouble detecting odors. In addition, 1,563 were included who did not report that problem. Nearly all of the volunteers had a documented COVID-19 infection. The researchers tested participants’ ability to smell. 80% of those reporting olfactory difficulties had tests confirming the problem. Somewhat surprisingly, 66% of those who did not report trouble smelling also had some abnormalities in their sense of smell. Of those, 8% were severely impaired. Not being able to smell is bad enough. The investigators also report a link between an impaired sense of smell and cognitive difficulties or brain fog. Scientists suggest that these deficits could have a profound impact on people’s well-being.

Joe

02:26-03:23

The FDA first approved the anticoagulant heparin in 1939. It was originally used to prevent blood clots. A new study of COVID patients demonstrates that heparin can prevent severe complications from SARS-CoV-2. 238 patients with COVID were assigned to receive inhaled heparin. Another 215 received standard of care and 25 got placebo. In-hospital death was far higher in the control group. Heparin is not just an anticoagulant. It also has antiviral and anti-inflammatory activity. Administering it in inhaled form can prevent lung injury and blood clots in the lungs. The researchers suspect that heparin could be beneficial against other serious lung infections, such as pneumonia or influenza.

Terry

03:24-04:59

It may sometimes seem that people who have heart attacks or strokes are struck down out of the blue. A new study suggests that instead, nearly everyone who experiences a cardiovascular event had at least one suboptimal risk factor beforehand. The research included more than 9 million adults in Korea. A routine screening in 2009 recorded blood pressure, cholesterol, blood glucose, and smoking history. The scientists also checked prescription records for medicines used to treat these problems. When researchers checked participants’ health records after 13 years, they were able to see who had developed cardiovascular complications and who had not. They also studied nearly 7,000 American adults participating in the multi-ethnic study of atherosclerosis. These middle-aged to older individuals did not have heart disease when the study began. They, too, had their blood sugar, blood pressure, and cholesterol measured, and they reported if they were smokers. Nearly 18 years later, the investigators determined who suffered heart attacks, strokes, heart failure, or cardiovascular death. In both Korea and America, 96% of those who experienced complications had blood pressure above 120 in the initial screening. Even though this wasn’t technically hypertension, it was considered non-optimal. High cholesterol and high blood sugar were also common. Most people had multiple risk factors.

Joe

05:00-05:35

The CDC is reporting an alarming rise in drug-resistant bacteria called NDM-CRE. This group of germs has surged in recent years and can cause pneumonia, urinary tract infections, sepsis, and wound infections. These bacteria are highly resistant to existing antibiotics. That makes treatment very challenging. Experts recommend testing and preventive strategies such as adherence to disposable gowns, gloves, and masks when interacting with patients.

Terry

05:36-06:20

People at high risk for cardiovascular disease are sometimes encouraged to take aspirin as a preventive. A new study investigated whether the PREVENT risk calculator can determine who might benefit from aspirin for prevention. The vast majority of those who reported taking aspirin to prevent heart attacks did not qualify based on the PREVENT Risk Calculator. And that’s the health news from the People’s Pharmacy this week. Welcome to the People’s Pharmacy. I’m Terry Graedon. I’m a medical anthropologist.

Joe

06:20-06:42

And I’m Joe Graedon. I’m a pharmacologist. Today, our lines are open for your calls and questions. Have you had a bad fall while taking a medicine that made you dizzy or drowsy? We want to hear your story. Our lines are open at 888-472-3366.

Terry

06:42-06:49

Today’s topic is about avoiding falls and becoming aware of which drugs might increase the risk of falls.

Joe

06:49-07:07

To start off, we’re talking with Dr. Thomas Farley, professor of community health at Tulane University. Dr. Farley wrote an alarming analysis in JAMA Health Forum in August titled, Risky Prescribing and the Epidemic of Deaths from Falls.

Terry

07:08-07:12

Welcome to the People’s Pharmacy, Dr. Thomas Farley.

Dr. Thomas Farley

07:12-07:13

Thank you. It’s good to be here.

Joe

07:14-07:34

Dr. Farley, we saw your opinion piece in JAMA Health Forum a little while ago, and it really got our attention. It was titled Risky Prescribing and the Epidemic of Deaths from Falls. Tell us a little bit about what prompted this really important article.

Dr. Thomas Farley

07:35-08:20

Well, so I’m an epidemiologist and a doctor who works in public health and was writing a textbook for public health students on the roughly 30 leading causes of death in America. And one of those is falls in older adults. And as part of my routine research for the textbook, I looked at trends in falls. And I was shocked to see that over roughly the past 30 years that the mortality rate from falls in the United States has roughly tripled. We now have about 45,000 people dying per year from falls over the age of 65. And I found that that increase had not been seen in other countries around the world. The U.S. is an outlier of this. So I said this is an important problem that people need to understand what’s behind it and also to take seriously.

Terry

08:22-08:53

And, Dr. Farley, we want to ask you what the reasons might be. What you wrote was, in 2023, more than 41,000 individuals older than 65 years died from falls. Among older adults, the number of deaths from falls is more than from breast or prostate cancer and is more than from car crashes, drug overdoses, and all other unintentional injuries combined. What the heck is going on?

Dr. Thomas Farley

08:54-09:43

That was exactly the question I had. What the heck is going on? Why are we seeing this tripling of falls to where now this is really an important cause of death in America today? You know, older adults have always fallen. They’ve always been at risk for the falls. But we’re seeing, why would we be seeing this increase? And so the next thing I did was to say, well, what are the things that put people at greater risk for having a serious fatal fall? And there are things like having a physical disability, having vision problems, maybe having cognitive problems like early dementia, living alone, having a cluttered household, using alcohol. But none of those things have any reason to think that they would have tripled in the past 30 years. On the other hand, there have been big changes in prescribing a prescription drug to older adults. So that’s what led me to really look into what has happened with the prescription drugs in the past 30 years.

Joe

09:44-10:54

So let’s drill down on the medications, if you don’t mind. You know, there are some drugs that are highly sedating, you know, the anti-anxiety agents, what we call the psychotropics, the drugs for schizophrenia, for example, or severe depression. But there are lots of other medications that can make people feel dizzy. And I think that a lot of doctors just sort of pass over that pretty quickly without really asking people, “is this medicine making you feel dizzy?” And I’m particularly thinking about high blood pressure because the guidelines now say 120 over 80. Doctor, you’ve got to get everybody. I don’t care how old they are. Everybody needs to be under 120 over 80. And yet that may take three, four, or five different blood pressure medications to achieve that goal. And that can lead to something called orthostatic hypotension and dizziness. So if you could drill down a little deeper on the blood pressure problem.

Dr. Thomas Farley

10:54-12:01

If I could, first I’ll talk about the drugs that affect the brain in other ways that you mentioned. Really, any drug that makes you drowsy or clumsy, sedating, is going to increase your risk of falls. Those are things that the drugs that I worry about the most. But then, as you say, there are other drugs that affect your heart and cardiovascular system, which may cause people to just have less blood flow to the brain over a very short period of time, and they can have a fall from that. As I look at the data, I have to say I’m more concerned about the first category, the central nervous system active drugs, than I am about the blood pressure drugs. Blood pressure absolutely is a serious problem, increases your risk of heart disease and stroke and kidney failure. People with hypertension need to be on medications, but there are safer high blood pressure drugs than there are less safe high blood pressure drugs. And so it is fair for people who are older adults who are on a high blood pressure medication to talk to their doctor, say, is this one of those high blood pressure meds that’s going to increase my risk of falls? Is this one that is safer?

Terry

12:02-12:38

Now, Dr. Farley, in the article in JAMA Health Forum, you do talk about categories of medications that might make people drowsy or woozy. Benzodiazepines, for example. And when we write about benzodiazepines, which we do from time to time, we usually say this category of drugs is generally considered inappropriate for older adults. Are doctors paying attention or are they still prescribing benzos for older people?

Dr. Thomas Farley

12:39-13:22

They’re still prescribing benzos for older people. From what I could find, there’s not as much research on this as I would like to see. But I found one study that looked at people over the age of 85 who were seen in an outpatient setting, 20% of them were giving prescriptions for benzos. That’s absolutely a very high-risk drug for them, and that’s not appropriate. I mean, overall, there was a study done, published in JAMA Internal Medicine, that showed more than 90% of older adults are taking prescription drugs, and 45% are taking prescription drugs that are considered to be potentially inappropriate. So there’s an awful lot of prescribing going on out there on drugs that are potentially quite risky, benzos being one of them that make me worry a lot, but others as well.

Joe

13:23-14:16

We’re talking about diazepam, Valium, alprazolam, Xanax. These are drugs that a lot of people take for anxiety. But there are also problems for some people with antidepressants that can make them feel dizzy as well. And millions of people are taking antidepressants on a regular basis. I’m also wondering about antihistamines because, you know, people, if they have stuffy nose or allergies, are likely to take over-the-counter drugs. And some of them, like diphenhydramine, Benadryl, can make people very woozy. And now all the PM pain meds, you know, the Aleve PM and the Advil PM and the Tylenol PM, they all contain diphenhydramine. And for some people, they may have a little wooziness if they have to get up in the middle of the night.

Dr. Thomas Farley

14:18-14:39

Yeah. So I think of antihistamines in two categories. There’s kind of the older ones, as you mentioned, diphenhydramine, that absolutely make people that are sedating and make people clumsy so they could increase the risk of falls. The newer ones are probably less likely to do that. And I don’t have data out there as to which ones are prescribed more these days or whether there’s an increase in one category or the other. But that’s absolutely something that I would be concerned about.

Joe

14:41-15:40

I have a letter that we received from one of our readers. She says, a few years ago, my cardiologist put me on spironolactone to lower my blood pressure from 140 over 80. Shortly thereafter, I got up from bed for the bathroom. I blacked out in the bathroom, fell, and fractured two vertebrae. I was given a walker and kept on spironolactone. Later, I was using the walker to get to the bathroom in the middle of the night. I blacked out again, fell onto the walker and cut both knees. That resulted in a three-week stay in a rehab facility. My cardiologist never mentioned that spironolactone might make me faint or fall. I’m no longer on any blood pressure medication, but due to the fractures, I am four inches shorter and my life has been changed forever. I think we sometimes forget that, you know, dizziness sounds like such a mild side effect, but it can have devastating consequences.

Dr. Thomas Farley

15:41-16:05

Yeah. You know, for women in particular, a fall, even a small fall can lead to a hip fracture and hip fractures absolutely can be fatal on older adults. And so, you know, I, I, there definitely are some antihypertensives that are going to increase the risk of falls more than others. And so, again, I’m a big believer that we should treat people with hypertension. I don’t want anybody to get that impression.

Joe

16:06-16:07

Right.

Dr. Thomas Farley

16:06-16:15

But I do think that older adults need to be having a serious conversation with their physician about, are they on an antihypertensive that is going to be safe from a false perspective?

Joe

16:15-16:42

We just have a minute left, but it seems like very rarely do health professionals, especially family practice doctors or interns, actually check people for their potential for dizziness. It might happen at physical therapy. It might happen at health coaches. But shouldn’t doctors be checking for dizziness every time an older person comes in who’s taking many medications?

Dr. Thomas Farley

16:43-17:31

They should be assessing the risk of falls more broadly. And dizziness would be part of that, but also the other things, are they particularly physically frail, do they have vision problems? And look, there’s a falls risk checklist that they can use. And they ought to be far more careful with patients that are at risk of falls than those that have a lower risk of falls. I think more generally, this data says to me that not just individual doctors, but health systems as a group ought to be looking at this in the same way that they looked at opioids in the past and say, you know, we need to be pulling data on our providers and see who’s prescribing these fall risk increasing drugs or FRIDs a lot. And if so, have some conversations with them about how to get patients onto either drugs that are safer or to see whether they need to be on the drugs at all.

Terry

17:32-17:37

Dr. Thomas Farley, thank you very much for talking with us on The People’s Pharmacy today.

Dr. Thomas Farley

17:38-39

Thanks for having me.

Terry

17:39-17:47

You’ve been listening to epidemiologist and health educator, Dr. Thomas Farley of Tulane University. You can find a link to his paper on our website.

Joe

17:48-17:59

Our phone lines are open for your stories, comments, and questions. That number, 888-472-3366.

Terry

18:00-18:03

You could also put a comment on Facebook or at People’s Pharmacy.

Joe

18:04-18:15

Again, that number, 888-472-3366. We invite your questions about medications that might increase the risk for falls.

Terry

18:16-18:54

Again, that phone number for you, 888-472-3366. You’re listening to The People’s Pharmacy with Joe and Terry Graedon. Welcome back to the people’s pharmacy I’m Terry Graedon.

Joe

18:54-19:12

And I’m Joe Graedon.

Terry

19:12-19:23

Today, we’re talking about FRIDs, F-R-I-D. Is that acronym new to you? It was for us. It means fall-risk-increasing-drugs.

Joe

19:24-19:48

We invite you to share your story about a medicine that might have made you feel, you know, woozy or unsteady. Our number, 888-472-3366. Again, if you’d like to join our conversation. We are live in the studio, 888-472-3366.

Terry

19:49-20:38

And Joe, we have a comment from Jeannie. She says, I’m 80 plus years old. And at this point, I’m taking no prescription drugs because every one of them has side effects. I have high blood pressure, 142 over 70. And my doctor wanted me to take losartan. After reading the side effects, I decided the answer would be no, because it can cause dizziness. It can also lower your heart rate, and mine’s already low. I average 40 beats a minute, and when I’m asleep, sometimes it’s 30 beats a minute. Taking Losartan means I could fall and maybe break a hip. Some seniors who break their hips have died within a year because of the stress on their bodies. Why would I want to trade one problem for another problem? Very good point. We do need to point out, you have to do the balancing act, right?

Joe

20:38-21:25

You do have to do the balancing act. It is critical to keep your blood pressure under control. We don’t want anybody allowing blood pressure to skyrocket. But sometimes trying to get everybody down to below 120 over 80 can lead to dizziness, especially something called orthostatic hypotension. It’s when you stand up suddenly and then all of a sudden you get dizzy and then you may fall. And that’s because of the blood pressure medication. So as Dr. Farley said, you want to make sure you talk to your doctor about drugs that don’t make you feel dizzy. Again, our phone lines are open. 888-472-3366 is the number to call if you have a story to share.

Terry

21:26-21:30

And we go to Arlington, Texas to talk to Ann. Ann, your question, please.

Caller

21:33-21:48

Hi, this is Ann. I was wondering if I only take Synthroid in the morning before I eat, but I’m dizzy right when I get up, and then I’m kind of dizzy until I eat more during the day. How do I figure out what’s making me dizzy?

Joe

21:50-21:58

Good question, Ann. Well, first, are you taking any other medications besides Synthroid, which is a thyroid medication, right, Ann?

Caller

21:59-22:09

Yes. Just later in the day, I take hydroxychloroquine and some supplements, calcium and that kind of thing.

Terry

22:10-22:26

Usually, we don’t think of supplements as causing dizziness. And generally speaking, Ann, I wouldn’t expect Synthroid to cause much dizziness either. This sounds like you may need to have a more in-depth conversation with your doctor.

Joe

22:26-23:16

You know, I’d have to look up hydroxychloroquine, Terry, because, you know, it is a drug that is prescribed. It’s an old-fashioned medication. It’s sometimes used for arthritis symptoms, for example, or other autoimmune conditions. And so it’s not clear to me if that could be a contributor. But you definitely want to be very careful when you get up in the morning and so that you don’t, you know, on your way to the bathroom, for example, have a fall. So that’s a critical issue to bring up to your doctor whenever you get a chance. Okay. Thank you so much for your call. Bye bye. Terry, it looks like you’ve got Bert in Clearwater, Florida.

Terry

23:16-23:19

Let’s go to Bert and find out what’s on his mind.

Joe

23:21-23:21

Hi, Bert.

Terry

23:21-23:22

Hey, Bert.

Joe

23:22-23:22

Are you there?

Caller

23:24-23:25

Hello, yes.

Joe

23:26-23:26

Go ahead, please.

Caller

23:27-23:50

I’m here. What’s your question? I was just calling in to say that with respect to dizziness, I’ve had some problems with taking Flomax and drugs for a similar kind of problem. And that I find that, you know, like I’m sitting on a couch or something like that, I’ll get up and I’ll be busy and have to put a hand out and steady myself.

Terry

23:51-23:52

That’s, yes.

Caller

23:52-23:58

For a few seconds or whatever until that goes away. And then it’ll go away and then I go ahead with what I’m doing.

Joe

23:59-24:26

Bert, you’re describing a classic case of orthostatic hypotension. That’s the doctor’s term for stand up, oops, feeling dizzy. And what that means, quite honestly, is that you’re going to have to get up from the couch cautiously. So don’t ever stand up suddenly and start walking because you might end up on the floor.

Terry

24:27-24:30

Bert, did we interrupt you before you were finished with your story?

Caller

24:31-24:34

No, no. I think I got everything out.

Joe

24:35-24:56

Okay. Well, excellent. Be careful. And we do understand that sometimes Flowmax is essential to help you not have to get up three, four, five times in the middle of the night to go to the bathroom. That’s when it’s especially important to be careful if you do get up to go. So thanks for the call. Let’s just give the phone number again, Tara.

Terry

24:57-25:13

Absolutely. 888-472-3366. That’s our number. We’d love to talk with you and hear about your experience. And let’s talk to Janet in Pittsboro, North Carolina. Janet, tell us your story, please.

Caller

25:13-25:14

How are you?

Joe

25:14-25:15

We’re doing well.

Caller

25:15-25:40

I am with uh, prescribed [muffled], which is also called sertraline, to help me sleep. I have a problem with insomnia. And the prescription is 50-milligram tablets. And it says take three to four tablets by mouth at bedtime as needed. I cannot. That’s an overdose to me.

Terry

25:40-25:40

Yeah.

Caller

25:41-26:14

But not too long ago, I took two. And right before that, I took one 5-milligram diazepam. And I fell. And I had fallen last October a year ago, almost exactly a year ago. And formaldehyde dust left in my house by a contractor, and I broke my femur. And that was a disaster. I mean, I was in ICU for 10 days, but that didn’t involve a drug. That involved me trying to clean up this dust.

Terry

26:14-26:14

Uh-huh.

Caller

26:15-26:23

But now, just the other day, well, September the 9th, I think, I fell again, but I was dizzy when I got up.

Terry

26:24-26:52

I understand, Janet. We actually would like to make some comments on what you’ve told us. And we’d like to remind everybody that when you want to talk to us on the show, you need to turn off your radio because otherwise it will be distracting for everyone. So, Janet, I’m going to hang up here and we’re going to make some comments about the diphenhydramine and the sertraline that you have been taking.

Joe

26:52-26:56

I thought I also heard her say something about diazepam.

Terry

26:57-26:59

I didn’t catch that, but it might have been there.

Joe

27:00-27:04

I thought I heard that. And that would be, of course, a benzodiazepine.

Terry

27:05-27:14

Sertraline is one of the medications that Dr. Farley was talking about that put older people, and it sounds like Janet might be an older person.

Joe

27:14-27:15

It does sound that way.

Terry

27:15-27:34

Put older people at risk for falls. And, Joe, we were talking about drugs that are prescribed. Sertraline is a prescribed antidepressant. Obviously, Janet’s doctor is prescribing it for her sleep. That’s an off-label indication.

Joe

27:34-27:41

I’m having a hard time understanding that. And she said three or four pills, and I’m thinking, what? Oh, whoa, whoa, whoa, whoa.

Terry

27:42-27:45

Yeah, that doesn’t sound like a good idea.

Joe

27:45-27:46

Well, first of all.

Terry

27:46-27:53

But diphenhydramine, Joe, in combination with sertraline or even by itself, tell me about diphenhydramine.

Joe

27:53-27:59

Well, of course, we’re talking about Benadryl. We’re talking about the PM in Tylenol PM.

Terry

27:59-28:12

And a lot of people who have trouble sleeping will take this medication, which is over the counter. You can take it every day without even telling your doctor. But we’d like to suggest you need to tell your doctor.

Joe

28:12-28:28

And we’d also like to suggest that if you have to get up in the middle of the night to go to the bathroom, it would not be a good idea to take any of those PM pain medicines because they could make you woozy, you know, at three in the morning when you get up.

Terry

28:28-28:39

And sertraline as a sleeping pill, if you’re susceptible to falls, is a bad idea. Get your doctor to give you something better.

Joe

28:39-28:45

Let’s talk about the “Beers” list. And we’re not talking about drinking beer.

Terry

28:46-28:54

No, we’re not. We’re talking about a gentleman whose last name was Beers who was concerned about this type of problem.

Joe

28:54-29:01

It was spelled B-E-E-R-S, Dr. Beers. And before we do that, Terry, what’s the phone number?

Terry

29:02-29:12

The number is 888-472-3366. And Joe, tell me more about Dr. Beers and his list.

Joe

29:12-29:26

Well, he created a list many decades ago, and he said to his colleagues, doctors, don’t prescribe drugs on my Beers list because it will make them vulnerable to lots of problems.

Terry

29:27-29:48

So the drugs that Dr. Beers put on his list are drugs that are potentially inappropriate for older people. And sometimes referred to as PIP, Potentially Inappropriate Prescriptions. But basically, we’re talking about older people because they’re more vulnerable to problems with certain drugs.

Joe

29:48-29:55

Well, what’s become very popular these days is a category of drugs called gabapentinoids.

Terry

29:55-30:01

And we’ve got a comment on that, Joe, from Facebook. Would you like to hear it first? And then you can launch into your…

Joe

30:01-30:02

I would like to hear it.

Terry

30:02-30:28

Okay. Mary Jo wrote, I’m a paramedic. I have a question about Neurontin. People are prescribed this all the time for their peripheral neuropathy, which makes them a fall risk anyway. But when elderly people consume it, they have a bigger risk of falling. And I can’t read the rest of Mary Jo’s comment, sorry to say. So now you get to carry on about Neurontin.

Joe

30:28-30:34

Mary Jo is a paramedic. So she is likely to be in that emergency.

Terry

30:34-30:37

She gets called. When somebody falls.

Joe

30:37-31:17

When the ambulance comes, that’s Mary Jo. And, you know, the gabapentinoids, and that’s gabapentin, it’s pregabalin, Lyrica. She mentioned Neurontin. And these drugs are now being prescribed so widely for pain, especially for nerve pain. So gabapentin is the number five most prescribed drugs in America today. You know, so many people are in pain and they can’t take opioids because their doctors are afraid of them or they’re afraid of them. And as a result, they’re put on gabapentin. And it can make people vulnerable to falls.

Terry

31:17-31:19

It can definitely do that.

Joe

31:19-31:43

That number again, 888-472-3366. If you’d like to join our conversation, are you taking one, two, three, maybe four blood pressure medications simultaneously? How does that affect your level of dizziness? We’d love to hear from you. Again, that number, 888-472-3366.

Terry

31:44-31:49

And we go to Peggy in Auburn. Peggy is, where is Auburn exactly?

Caller

31:50-31:53

It’s in the southeast corner of Nebraska.

Terry

31:53-31:54

Wonderful.

Joe

31:54-31:56

Right next to Iowa and Kansas.

Terry

31:56-31:57

Okay.

Joe

31:58-31:59

Terry, where did your mom grow up?

Terry

31:59-32:07

In the western corner of Nebraska. We’re not going to get into geography. We don’t have time for geography, but I appreciate that.

Caller

32:07-32:28

Now, your story, please. I am taking two blood pressure medications. And at the time, amlodipine and my doctor prescribed hydrochlorothiazide. And that made me dizzy. And I passed out. I walked outside. It was sunny. It was warm. Went to the ground.

Joe

32:29-32:29

Oh, my.

Caller

32:29-32:37

Fell to the ground. I called him and told him he changed the medication to metoprolol. Okay.

Joe

32:38-32:40

Metoprolol, right. A beta blocker.

Caller

32:40-32:40

Metoprolol, yes.

Joe

32:41-32:46

And were you able to get up and manage to not break any bones on that fall?

Caller

32:47-32:51

I did not break any bones. I’m 59 years old. Okay.

Terry

32:52-33:16

So the people who are most likely to break bones are the really older people, you know, 80 and older. So we’re glad you didn’t break anything, and we’re glad that you realized that the drugs causing your problem were your blood pressure medicines, and you got your doctor to change the prescription. Good work, Peggy. Thanks for calling.

Joe

33:18-33:19

We appreciate it.

Terry

33:20-33:22

And, Joe, we’re getting close to our break, aren’t we?

Joe

33:22-33:40

Oh, we got lots of time. Okay. I think it’s been so long since we’ve done a live show, we kind of have forgotten the time cues. Al, we’re still good, right? Yeah, we still have two minutes. Okay. So shall we go to Herb?

Terry

33:40-33:41

Sure.

Joe

33:41-33:46

In Research Triangle Park, North Carolina. We can just squeeze Herb in.

Terry

33:46-33:48

I think we have enough time to talk to Herb.

Joe

33:48-33:49

Herb, what’s the story?

Caller

33:51-33:52

Hi.

Terry

33:52-33:52

Hi.

Caller

33:52-35:19

Terry and Joe. Good conversation. I don’t know what to say. Here it is. I have a 97-year-old mother who has no issues other than she is not 120 over 80. Oh, my. So she has been prescribed amlodipine, the sort of those kind of things. I have been fighting this battle for some time. So what I would like to say is that your audience, don’t give up the fight. Don’t give up the fight. What I did was I said, look, when she goes into to see the doctor, she’s excited because she gets the white coat syndrome. So what I do is I have her and me to take her blood pressure in an ambulatory way throughout the week, not just there. So that would be my suggestion to people. At 97, she does use a walker. I will say that. But I think sometimes trying to do good does not always end up being good for a 97-year-old mother. And I thank you all so much every week for what you do, and I also do your subscription as well. Herb, thank you so much for that call.

Terry

35:20-35:38

And thank you for watching out for your 97-year-old mother. The fact that she uses a walker is very smart. And the fact that you are taking her blood pressure, making a record of it so that you can show the doctor what her blood pressure is like at home, that makes a lot of sense.

Joe

35:38-37:00

Well, you know, this idea of white coat hypertension is something that I think a lot of people have to struggle with because, you know, they have to drive to get to the doctor’s office. If there’s traffic, it can be very anxiety producing. And then the question becomes one of how well is your blood pressure taken at the doctor’s office? When we come back after the break, we’re going to ask you to give us a call about how your blood pressure has been taken. So there are some guidelines from the American Heart Association. You’re supposed to, number one, be allowed to rest quietly for about five or 10 minutes when you get to the doctor’s office. You’re encouraged to go to the bathroom and pee. And then when you get into the office, they need to make sure that they take it correctly, that you’re not sitting on the exam table with your arm dangling down, that you’re in a chair with your arm supported. Has that happened to you? I’m curious. Have you been encouraged to follow those guidelines or did they just take your blood pressure as soon as you walk in the door? Give us a call. Tell us about your experience with white coat hypertension. Our lines are open at 888-472-3366. You can send us something through Facebook.

Terry

37:00-37:14

That’s right. Facebook or at People’s Pharmacy. And that’s how we got Mary Jo’s comment. And, you know, when we come back from our short break, we will talk more about drugs that increase the risk of falls, but we’ll especially get to the blood pressure.

Joe

37:15-37:20

888-472-3366 is the number to call.

Terry

37:38-37:41

You’re listening to The People’s Pharmacy with Joe and Terry Graedon.

Joe

37:51-37:53

Welcome back to the people’s pharmacy I’m Joe Graedon.

Terry

37:54-38:12

And I’m Terry Graedon.

Joe

38:13-38:23

Have you ever been warned about drug-induced falls? Has your doctor evaluated you for such a risk, and how would they even do that?

Terry

38:24-38:40

I’m not sure how they would do that, but there are some tests that they use to see how people can get up out of a chair and that sort of thing. So there may be assessments.

Joe

38:36-38:38

Well, you know, physical therapists do this all the time.

Terry

38:39-38:41

That’s true. They check your balance.

Joe

38:41-39:03

And doctors should be trained so that they do know how to test a, not just an older person, anybody for a fall risk, especially if they’re taking more than one or two medications. And I suspect that if you were to ask a lot of nurses these days, when a patient comes in, How many drugs are they taking? I bet the average is more than two.

Terry

39:04-39:21

Especially if someone is struggling with high blood pressure. Now, I love the idea that Herb suggested a few minutes ago that you should take your blood pressure at home and keep a record of it. So you know what it’s like throughout the day and you can share that with your doctor. That’s important.

Joe

39:21-39:31

And, you know, does a 97-year-old woman need a whole bunch of medications to get her blood pressure under 120 over 80?

Terry

39:32-39:43

The idea is that you’re going to increase longevity. But once you get to 97, I don’t know that you’re aiming for greatly increased longevity. She’s already there.

Joe

39:43-39:45

The risk of a fall.

Terry

39:45-39:47

Is significant.

Joe

39:47-40:11

And worrisome. I remember my mom went in to see Dr. Bob Gutman, who was an internist, and he said, Helen, I could get your blood pressure down to 120 over 80, but you’ll feel bad. And are you willing to take the risk for a stroke and let it be a little higher? And she said, yes, Dr. Gutman, I’m willing. And she lived to 92 and died from a medical mistake.

Terry

40:12-40:18

But she chose not to have a fall because the idea of a fall frightened her.

Joe

40:18-40:21

It sure did. You have a story from Jane.

Terry

40:22-41:32

I do have a story from Jane, and then we’ll go to the calls. Jane said, I worry about how often doctors put people on blood pressure drugs based on one reading at the clinic. Way too often that reading was gotten by totally incorrect methodology. Like many people, I have white coat hypertension. And Joe, when we’re done with Jane, we’ll ask you to explain that. I now take a chart of at-home readings covering the last 10 days to two weeks of several readings a day. Even though these are perfectly fine numbers, I still have to fend off the doctor wanting to start me on meds based on the somewhat high reading at the office. Also, in the last 20 years, my pressure has been taken correctly only two or three times. I wonder how many people are dutifully taking their medication every day based on a single reading done improperly at the doctor’s office and therefore are perpetually experiencing low blood pressure or maybe dizziness at home. I suspect a fair number of falls, appearances of cognitive decline, etc. are the result of this unfortunate dogma. So we appreciate Jane’s comments.

Joe

41:32-42:04

We surely do. And this idea of white coat hypertension has been controversial for decades. There are some people who say, oh, that’s all nonsense. If somebody has 130 over 90 in the doctor’s office, they have to be treated, even if their blood pressure is 120 over 80 at home. I think that thinking is starting to disappear. I hope it is, because a lot of times these days, people are not getting their blood pressure taken correctly.

Terry

42:04-42:11

Let’s talk to Patricia in Wilmington. She’s got a story about a drug we haven’t mentioned yet. Patricia, welcome to the People’s Pharmacy.

Caller

42:13-43:04

Thank you. Hi. Yes, first time caller. My husband is 86 and he takes many drugs for a variety of issues. But one of the drugs that he’s been prescribed over the years is Viagra. And I’m not sure why 86, you still need to be taking Viagra, but that’s a whole nother story. Sometimes he’ll take more than what’s prescribed because he’s not getting the effects that he wants. So he’ll take two or three. And that’s caused him to get dizzy and lightheaded. And so I plan to go to his doctor with him the next visit to have a discussion about does he really need to continue to have the Viagra and also the importance of taking just the prescribed amount

Terry

43:04-43:24

and not what you think you need. Such a great comment. And I don’t think people actually appreciate that Viagra can make you dizzy, especially in combination with other medications or if you take more than the prescribed amount. So, Patricia, we really appreciate this comment.

Joe

43:25-43:39

That voluntary dose increase of two or three Viagras would definitely be problematic. The dose is 100 milligrams. So if he were taking 200 or 300 milligrams, whoa.

Terry

43:39-43:44

And, of course, falling would be the least romantic thing you can possibly think of.

Joe

43:45-43:50

Exactly. So, yes, definitely discuss with his doctor this potential problem.

Terry

43:51-43:56

And we’ve got a call from Ken in Medville or Meadville, Pennsylvania.

Joe

43:57-43:58

I bet it’s Meadville.

Terry

43:59-43:59

Is that right, Ken?

Caller

44:01-44:03

Yes, yes, you are, Joe. Meadville.

Joe

44:04-44:11

I grew up in Pennsylvania. I went to Penn State, and there were a bunch of kids there from Meadville, Pennsylvania. What’s the story?

Caller

44:12-45:07

Well, I’m 79, and I’m on a medication called nadolol, 20 milligrams. I guess that’s a beta blocker, but it can be used for blood pressure, too. I missed the first few minutes of the show. I was wondering if that was one of the ones on the Beers list. And I’m having severe balance issues. I wouldn’t call it dizziness, but I can’t seem to walk down the sidewalk when I’m out walking straight. I kind of wander back and forth. I can’t stand on one foot. I’ve always been athletic. I still can play table tennis quite actively.

Joe

45:09-46:24

Well, let’s start at the beginning. You’re taking a beta blocker, as you have pointed out, nadolol. And to be honest with you, physicians have generally moved away from beta blockers for high blood pressure as the first line approach. In fact, I can’t say off the top of my head if nadolol is on the Beers list, but I can say quite confidently that most physicians would not start with a drug like nadolol to control blood pressure. And so even if you’re not quote unquote dizzy, if you’re unsteady on your feet, it is absolutely time to be in touch with your doctor and say, let’s try something else. And that something else might be a drug like a diuretic. It might be a medication like an ACE inhibitor. But you definitely need to talk to your doctor because if you’re feeling unsteady, if the possibility is when you’re walking on the sidewalk or someplace else and you fall, it could be a disaster. So Ken, thank you so much for calling and please do follow up with your physician as soon

Terry

46:24-46:32

as possible. Shall we go to Richmond, Virginia and talk to Ann? Absolutely. And our numbers are

Joe

46:32-47:08

888-472-3366. We just have a few minutes before we have to sign off. We’d love to hear from you, especially about how your blood pressure has been taken in the doctor’s office. Has it been done correctly? Has it been taken by a nurse, a doctor, or a technician? Did your arm get supported at chest or heart height? Because a lot of times your arm will be dangling or it’s not supported that can affect your blood pressure reading. But where are we going to? Richmond, did you say, Terry?

Terry

47:08-47:14

Yes, we’re talking to Ann. She’s been waiting to make her comment or ask her question. Go ahead, please, Ann.

Caller

47:16-47:38

Hi. I have eye issues. I have glaucoma and other eye issues and have been treated with lots of different meds. But the longest one is Latanoprost and also dorzolamide, timolol. I wonder if there are any eye meds that I should be careful of for dizziness because I’m dizzy.

Joe

47:38-47:55

You know, and that’s a brilliant question. And thank you so much for asking about eye meds. Because I think a lot of times people assume, oh, well, if I just put a drop in my eye, it’s just going to stay in my eye. It won’t have an impact on the rest of my body.

Terry

47:55-48:03

But timolol, for example, we know for sure that it can have an impact. And it’s possible that Latanoprost also does.

Joe

48:03-48:24

Well, timolol is a beta blocker, and we just ended up talking about beta blockers. And so you should definitely talk to your doctor about this if you are feeling somewhat dizzy as a result of your eye drops. So, you know, when you put eye drops in your eyes, they don’t just stay there. They circulate through the rest of your body.

Terry

48:24-48:28

Now, of course, you do need to treat your glaucoma.

Joe

48:28-48:28

Absolutely.

Terry

48:28-48:46

So you and your doctor are going to have to come up with a regimen that will work for the glaucoma and not put you at risk of a fall. So good luck with that, Ann. We sure hope you come up with something helpful. And Joe, did you want to talk to Eric in Charleston, West Virginia?

Joe

48:46-48:54

Absolutely. Eric, welcome to the People’s Pharmacy. What’s this about blood pressure cuffs? Well, good morning.

Caller

48:55-49:37

Yes. I have two items, actually. The cuff was interesting because at one point I went to my GP and the nurse came out and took my blood pressure and it was way up, way too high. And then the doctor came in and said, hmm, we used the wrong cuff. Your arm happens to be a little larger than usual and therefore we need to give you a big cuff. And so we took it and it came back 10 points lower than when it was. So it seemed to be very important to pick the right cuff, especially if your arm is larger than normal.

Terry

49:38-50:16

Absolutely, Eric. And the same thing holds true. If your arm is extra small, you need the right size cuff. Because if your arm is extra small and they use an ordinary cuff, your blood pressure reading is going to be a little bit too low. And Joe, we got a Facebook comment from Karen who says, I think something needs to be said about the devices being used to check blood pressure nowadays. I’m 65. I’ve had great blood pressure around 120 over 70 my whole life. But about 15 years ago, I noticed that my blood pressure registers higher in the doctor’s office. And it probably has something to do with the cuff.

Joe

50:16-50:55

Well, the cuff is one of those things that is often not even considered. I mean, because if you’re the patient and you walk into the doctor’s office, they slap the cuff on your arm. They never measure your arm. So if you have a very small arm or a very large arm, I mean, imagine a guy six feet, four inches tall, weighs 250 pounds, lifts weights. He’s going to have a gigantic bicep. And if they use a standard cuff on him, it will be an inaccurate reading. When’s the last time you ever had your arm measured before you had your blood pressure taken?

Terry

50:55-51:01

Well, let’s talk to Phil in Clearwater, Florida, because he’s got some stories to tell. Hey, Phil.

Joe

51:03-51:05

Hello. How are you today? We’re doing well. What’s up?

Caller

51:06-52:03

Well, I just want to give comments. I concur with you that a lot of physicians or their staff do not let you take time. And like sometimes I go to the doctor’s office and, you know, I’ve showered and got ready and I ran in there. And, you know, then they take you back and boom, they take your blood pressure right away and it’s elevated. And then they say, well, I’ll take it again. The doctor takes it like at the end of the exam and it’s back to normal. Same thing happened to my wife. She went there and I swear they want to put a diagnosis of hypertension in your chart so that they can charge more to the insurance company. But I don’t know if that’s true or not. That’s my hypothesis. But I just think you need to take control of your own body, your own medication, and tell them, no, I want you to wait five or ten minutes. Let me relax here a second. So it’s stressful enough going to the physicians anyway. But on top of that, I think they’re not always doing it correctly. So I concur with what you said.

Joe

52:03-52:22

And there’s one other thing, Phil. You should never talk when you’re having your blood pressure taken. Because if the technician or the nurse starts to ask you questions like, how are you doing? Or what’s going on in your life? Or some other medical question, talking will raise your blood pressure.

Terry

52:23-52:47

Joe, in fact, we got a Facebook comment from Renee who says, for white coat hypertension syndrome, show the nurse a note that says, no talking until after I weigh, relax, and they take my blood pressure. They rush you and they want to ask you all kinds of questions and show their incompetence before taking my vitals. Thanks for that, Renee. Yes.

Joe

52:47-52:53

And always go to the bathroom. You’re supposed to urinate before you have your blood pressure taken.

Terry

52:53-52:58

I don’t believe I have ever been asked if I needed to use the facilities.

Joe

52:59-53:01

I’ve never had that happen to me either.

Terry

53:01-53:04

Do we have time to talk to Johnny in Fort Worth or?

Joe

53:04-53:07

Very briefly, Johnny.

Terry

53:07-53:08

We’re almost out of time.

Joe

53:08-53:11

We have just a minute or two left. Go ahead, quickly.

Caller

53:12-53:43

Hi. Hi. I take a hormone drug. I have prostate cancer. And I also take four pills a day. I’ve lost four pills a day, but I’ve noticed that when I’m driving, sometimes I have an urge. I get anxious. And I’m just trying to figure out what’s going on. I don’t. My blood pressure usually runs by 140 over something. But that’s my issue. And I’m trying to think. I’ve been trying to work with my oncologist, trying to figure out what’s going on. Thank you.

Joe

53:43-54:07

You will need to work with your oncologist because, obviously, it’s critical that you keep your prostate cancer under control with your meds. But you don’t want to be dizzy while you’re driving. So that’s a critical point to bring up to your doctor. Well, Terry, we are just about out of time. I am so grateful for all of the calls we’ve had from all over the country.

Terry

54:07-54:54

And, Joe, we have one more comment. I think we have time for it. Jan says she’s a nurse in the emergency department. A woman brought her mother in because she was dizzy and nearly falling. Her doctor had prescribed a benzodiazepine, Librium, the day before her visit to the ED. Remember, Jan’s a nurse. She says, I informed the ED physician that her symptoms started right after she took the first dose. And the physician said it couldn’t be the medication because the dose was too low. He told her to call her doctor the next business day, which was two days from when we saw her. Her daughter was afraid to leave the patient alone at home, of course. Providers need to improve the medication reviews when patients’ experience falls.

Joe

54:55-55:08

Absolutely. And that is very good advice from a nurse. Thank you so much for that, Jan. Well, that is all the time we have today. Thank you so much for listening and sharing your stories today on The People’s Pharmacy.

Terry

55:09-55:20

Absolutely. And The People’s Pharmacy is a co-production of North Carolina Public Radio, WUNC, with The People’s Pharmacy.

Joe

55:20-55:35

Lynn Siegel produced today’s show. Pamela Alberta provided technical assistance. Al Wodarski, the great Al Wodarski, engineered. Dave Graedon edits our interviews. And the People’s Pharmacy theme music is by B.J. Liederman.

Terry

55:35-55:53

We would like to thank today’s guest, Dr. Thomas Farley, who is professor of community health at Tulane University. You can find a link to his article in our show notes. It’s the article titled Risky Prescribing and the Epidemic of Deaths from Falls.

Terry

56:08-56:31

Today’s show is number 1,447. You can find it online at peoplespharmacy.com. You can subscribe to our podcast through your favorite podcast provider. We post the show on our website on Monday morning. That’s where you can share your thoughts about this show. And you can email us your comments, radio at peoplespharmacy.com.

Joe

56:31-57:07

If you go to peoplespharmacy.com, you can sign up for our free online newsletter. It’s an easy way to stay on top of the breaking health news. By subscribing to our newsletter, you’ll also have regular access to our weekly podcast and find out ahead of time which topics we’ll be covering. And speaking of the podcast, Terry, we would be so grateful if our listeners would consider writing a review of The People’s Pharmacy and posting it to the podcast platform you prefer. And when you go to the YouTube channel, in about a week or two, you can see Dr. Farley and The People’s Pharmacy. In Durham, North Carolina, I’m Joe Graedon.

Terry

57:07-57:24

And I’m Terry Graedon. Thanks for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe
57:29 – 57:37

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

57:38 – 57:45

All you have to do is go to peoplespharmacy.com/donate.

Joe

57:45-57:56

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible. Thank you for your continued loyalty and support. We couldn’t make our show without you.