Carole, I respectfully disagree. I understand your concern that this scientific, factual presentation may seem to downplay the risks of these drugs — especially for the elderly. However, Joe has not, in my view, downplayed the risks. He has simply stated them factually without taking on the role of a physician, regulator, politician, or activist.

Given what this Website appears to be about, I think this is perfectly appropriate: Joe is not trained or licensed to practice medicine (although he may know almost as much as some doctors); he lacks the authority of a regulator; but, if he were to behave as does a politician or an activist, his readers wouldn’t take him seriously as an educator, which is what, I believe, he is trying to do.

In your practice, Carole, you must give each patient your best advice for their individual situation. You need not convince Internet readers of anything — your scientific objectivity, your independence, whatever. You work for each patient. Education may be a significant part of what you do with each patient, but you may do so in a more casual fashion, because you are working one-on-one.

I’m no expert, but I don’t think that most anticholinergics are, as you assert, OTC. Given the lists that I’ve seen, it would appear that the stronger anticholinergics include all the old antihistamines, most of which are OTC, but that’s all. No others are OTC. Some of the weaker anticholinergics are OTC, such as loperamide (the antidiarrheal known better as Imodium).

Furthermore, you state that “Many people take numerous anticholinergics on a daily basis.” To me, “numerous” suggests at least three or four. I don’t understand how your statement could possibly be true, except for two scenarios: (1) people who grossly abuse OTC antihistamines (no doctor involved, here); (2) you have a very expansive definition of what is included as an anticholinergic, thus including those drugs for which the anticholinergic effect is extremely mild (contrary to how the medical community views them).

In summary, I think Joe’s presentation seems accurate and balanced, with many citations and references for verification and further reading, all of which is appropriate for his Website. Similarly, Carole, what you do with your patients — including your quiet advocacy — is very appropriate for your practice. They are two very different businesses.