From Dr. K

As we age, its common to manage multiple health conditionsfrom high blood pressure and cholesterol to arthritis or sleep concerns. Often, each condition comes with its own prescription. Before you know it, your daily pill organizer is overflowing.

At East County Internal Medicine, we see many patients in Lakewood Ranch managing five, ten, or even fifteen medications at once. This is a clinical scenario known as polypharmacy, and while each drug may have been prescribed with good intentions, the combination can sometimes do more harm than good.

The Risks of Polypharmacy in the Elderly
The way our bodies process medication changes as we get older. Our kidneys and liver may not clear drugs as quickly, and our sensitivity to side effects often increases. When too many medications interact, the risks include:

• Increased Fall Risk: Many medications cause dizziness or sedation, which are leading causes of hip fractures and head injuries in seniors.
• Cognitive Confusion: What looks like early dementia or "brain fog" is sometimes simply a side effect of a specific drug combination.
• Drug-Drug Interactions: One medication might cancel out the benefit of another or, worse, create a dangerous new side effect.
• Prescribing Cascades: This happens when a doctor prescribes a new medication to treat the side effect of an existing medication, leading to an endless cycle of more pills.

What is Deprescribing?
The "traditional" medical mindset is often about adding treatments. However, a vital new trend in geriatric and internal medicine is deprescribing.
Deprescribing is the supervised process of reducing or stopping medications that may no longer be beneficial or may be causing unnecessary harm. It isn’t about "giving up" on treatment; its about optimizing quality of life.
Why Deprescribing is "The Harder Trend"
If adding a pill is easy, taking one away is surprisingly difficult. It requires:

1. Close Monitoring: We cant just stop a medication "cold turkey." It requires a careful "tapering" process to ensure your body adjusts safely.
2. Clinical Courage: It takes time and expertise to look at a patients entire history and decide which "maintenance" drug from ten years ago is no longer serving them today.
3. Patient Trust: We understand that many patients feel "protected" by their medications. Moving away from a long-term prescription requires a strong doctor-patient relationship.

How We Can Help
At East County Internal Medicine, Shaan Kunwar, DO, prioritizes medication reconciliation at every visit. Our goal is to ensure that every pill you take has a clear, evidence-based purpose that outweighs its risks.
The First Step: Bring a "brown bag" of all your current medicationsincluding over-the-counter supplementsto your next appointment. Together, we can review your list and determine if you are a candidate for a "medication spring cleaning."
Ready to simplify your health?
Schedule an appointment at East County Internal Medicine today.

Hi,
Over the years I’ve filled roles for regulating fraud, waste and abuse in Medicare, and the list of culprits is exhaustive, but one we’re going to talk about today is Hyperbaric Oxygen Therapy (HBO), in short, it’s a big waste of money and time, and doesn’t prevent amputations. Shut it down. Don’t make American tax payers pay for it.

Hyperbaric Oxygen Therapy (HBOT) has indeed been a major focus for federal investigators due to high rates of non-compliance and conflicting data regarding its clinical efficacy for common conditions like diabetic foot ulcers.
Fraud and Waste Data

• High Non-Compliance Rates: A 2018 audit by the HHS Office of Inspector General (OIG) found that 85% of sampled outpatient HBOT claims did not comply with Medicare requirements, leading to an estimated $42.6 million in overpayments for a single contractor alone.
• Major Settlements: In 2018, Healogics Inc., the nations largest wound care provider, agreed to pay up to $22.51 million to settle False Claims Act allegations that it knowingly billed Medicare for medically unnecessary HBOT.
• Strict Billing Controls: Due to high error rates and suspected overuse, CMS implemented prior authorization requirements for non-emergency HBOT in several states (Illinois, Michigan, and New Jersey) where spending was significantly above the national average.

Clinical Efficacy and Amputations

• Negative Large-Scale Findings: A major longitudinal study of over 6,000 patients found that HBOT did not improve wound healing or prevent amputations in patients defined by CMS eligibility criteria. In fact, those receiving HBOT were statistically more likely to have an amputation in that specific cohort.
• Conflicting Evidence: Some smaller studies or those focused on specific subgroups (like patients with Peripheral Arterial Occlusive Disease) suggest a reduction in major amputation rates. However, systemic reviews often conclude there is insufficient evidence to support routine use for diabetic foot ulcers.
• Cost vs. Benefit: While the cost per 40-treatment series has decreased to roughly $23,834, critics argue the lack of proven benefit for many patients makes even these lower costs a significant source of waste.

Supporters of the United States’ decision to leave the World Health Organization (WHO), which was formally initiated in January 2025 and completed in January 2026, cite several strategic, financial, and political benefits:

• Financial Savings: Proponents argue that the U.S. carried a disproportionate share of the WHO’s financial burden. Withdrawing allows for the redirection of hundreds of millions of dollarspreviously paid in mandatory dues and voluntary contributionstoward domestic health initiatives or direct bilateral partnerships.
• National Sovereignty and Autonomy: Leaving the WHO grants the U.S. greater independence in defining its own public health policies without the need to align with international guidelines that may not reflect its specific national priorities. This includes avoiding potential future obligations from international agreements like the Pandemic Agreement.
• Increased Accountability: The move is framed as a rejection of perceived mismanagement, lack of transparency, and the WHO’s failure to implement urgent reforms following its response to the COVID-19 pandemic.
• Independence from Political Influence: Advocates claim that the WHO has been susceptible to "inappropriate political influence" from other member states, specifically China. Withdrawing allows the U.S. to engage in "targeted global cooperation" directly with allies rather than through a multilateral organization they view as compromised.
• Competitive Global Leadership Model: Some argue that acting independently allows the U.S. to set its own benchmarks for health innovation and medical research, potentially creating a model that other nations may choose to follow outside of the WHO’s framework.
• Catalyst for Reform: Some scholars suggest that the withdrawal of its largest funder could act as a "wake-up call," forcing the WHO to undergo significant structural reforms to address its documented inefficiencies and funding models.