A new federal health care strategy.

patients examined in this study were taking cholinesterase inhibitors and 22% took memantine. Without strong empirical data, clinical judgmentmust rule.DavidKnopman,MD, a professor of neurology at theMayoClinic in Rochester, Minnesota, usually opts to continue cholinesterase inhibitors for patients withdementiawho liveathomebecausehe doesn’t want to run the risk of precipitating decline.But if apatient enters a skillednursing facility, he is likely to stop the medications. “If upon stopping them, the patient worsened, more resources would be at hand,” he said. Topping the list of medications that Sachsconsidersstopping inpatientswithadvanced illness are drugs to prevent osteoporosis. “They’re difficult to take and several studies have shown that if you’ve been on thesemedications for 5 years, their benefitscarryonforsometimebeyond,”hesaid. StephenKates,MD,HansjorgWyssprofessor of orthopedics at the University of Rochester School of Medicine and Dentistry inNewYork, agreed. Forpatientswith life-threatening cancer, advanced dementia, or end-stagepulmonarydisease, his recommendation is decisive: “Stop the medicine altogether.”