The journey from a troubling research finding to a real change in what doctors prescribe is rarely a short one. Reporting reviewed under Science X's editorial process describes a sequence that plays out again and again in geriatric medicine: researchers study a widely used drug and conclude it is less effective in older patients than previously believed, or that its risks outweigh its benefits for them. More studies follow and confirm the finding. After a few years, medical associations revise their guidelines, warning that the medication should be avoided or prescribed far more selectively. Still later, national prescribing data is examined to see whether use of the drug actually fell.
Often the answer is that it did decline — but not enough. In some cases, use barely budged or even increased, leaving a persistent gap between what the science says and what happens in exam rooms and kitchen-table pill organizers.
A gap that opens slowly and closes even more slowly
That lag is not simply a failure of communication. Part of it is logistical. Clinicians juggle enormous demands on their attention, and new findings can take considerable time to reach them in a usable form. Dr. Michael Steinman, a geriatrician at the University of California, San Francisco and co-director of the U.S. Deprescribing Research Network, describes the delay in practical terms: physicians have a vast amount of material to know and act on, and information may take a while to arrive.
But timing explains only part of the inertia. Steinman also points to the way clinicians and patients become accustomed to treating particular conditions in particular ways. Those approaches harden into ingrained habits, he notes, and because finding alternatives is genuinely difficult, it is easy to fall back on what you already know. The result is a kind of clinical momentum that keeps prescriptions flowing long after the underlying evidence has weakened.
Guidelines, warning labels and the Beers Criteria
The system does build guardrails, though they tend to appear years after the first signals. Professional medical associations eventually update their recommendations. A medication may be added to the Beers Criteria, an influential list of potentially inappropriate medications for older patients published by the American Geriatrics Society. When a drug is used preventively, the U.S. Preventive Services Task Force — an independent expert panel — may publish its own note of caution. The U.S. Food and Drug Administration can go further and issue "black box" warnings about side effects.
Each of these steps adds authority and visibility to a concern. None of them automatically rewrites the habits of a busy practice, and none guarantees that prescribing patterns will shift quickly at the national level.
Benzodiazepines: prompt relief, persistent questions
Recent studies of three medications or classes of drugs widely used among older Americans illustrate the problem, and the clearest example is benzodiazepines. Scientists began raising alarms about this class more than two decades ago, yet the drugs remain familiar names in many households. Valium, Xanax and Ativan are among the best known, along with the related "Z" drugs such as Ambien and Lunesta.
They are commonly prescribed for insomnia and anxiety, and their appeal is easy to understand. Dr. Mark Olfson, a psychiatrist and epidemiologist at Columbia University, notes that they offer prompt relief — a quality that makes them attractive to patients seeking fast comfort and to clinicians seeking a quick solution. That immediate benefit is precisely what makes the slower accumulation of safety concerns so difficult to act on.
Why medications are like barnacles
Steinman's metaphor captures the dynamic well. Medications, he says, resemble barnacles: they are easy to start but hard to stop. A prescription that begins as a short-term answer for a sleepless stretch or a stressful period can settle permanently into a daily routine. Removing it requires a deliberate conversation, a plan and a willingness to tolerate some uncertainty — all of which take time that neither patients nor physicians always feel they have.
Multiply that single decision by the many medications an older adult may be taking, and the scale of the challenge becomes clear. Each drug carries its own history of evidence, its own place in the guidelines and its own habits of use. Undoing even one entrenched practice is a project, not a moment.
Why stopping is harder than starting
Alternative approaches are rarely as simple as the original prescription. Replacing a medication may mean behavioral strategies, different treatments or careful monitoring, and each option demands effort from both clinician and patient. When the substitute is more complex or less immediately satisfying, the path of least resistance is to continue with the familiar drug.
This is why the research network Steinman co-directs focuses specifically on deprescribing — the structured process of reducing or discontinuing medications that are no longer helping, or whose harms now outweigh their benefits. The field exists because the problem is not isolated to one drug or one specialty. It is a structural feature of how medicine absorbs new evidence.
What the pattern reveals
- Evidence moves faster than practice. Studies accumulate, then guidelines change, then warnings appear — and only afterward does anyone check whether prescribing followed.
- Training becomes habit. Clinicians and patients grow used to treating conditions in established ways, and those habits are durable.
- Convenience favors the status quo. When alternatives are harder to arrange, continuing an existing prescription is the easier choice.
- Scale compounds the problem. Dozens of medications may be in play for a single older patient, each requiring its own reconsideration.
The recurring conclusion — yes, use declined, but not enough — is less an indictment of any single doctor than a description of how slowly health systems metabolize their own findings. Benzodiazepines show how long that process can take: more than 20 years after the first alarms, a drug class that offers prompt relief is still widespread among older Americans. Until stopping becomes as routine as starting, the barnacles are likely to keep accumulating.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
