The MacNeil/Lehrer NewsHour

MR. MacNeil: Good evening. Leading the news this Tuesday, Colombian police began proceedings to extradite a reputed cocaine finance chief to the U.S. Poland's Parliament set Thursday for a vote to confirm a Solidarity man as prime minister, Huey Newton, co-founder of the Black Panther Party was shot to death in Oakland. We'll have details in our News Summary in a moment. Judy Woodruff is in Washington tonight. Judy.

MS. WOODRUFF: After the News Summary, we turn to two major problems facing the prescription drug business, first, the scandal involving generic or non-brand name drugs. Food & Drug Administration Commissioner Frank Young and Congressman John Dingell, whose House committee exposed much of the wrongdoing, join us. Then overmedicating the elderly, we have a report, and finally, a documentary look at the voyage to the planet Neptune.NEWS SUMMARY

MS. WOODRUFF: National police officials in Colombia today began legal proceedings to hand over a reputed cocaine finance chief to the United States. The proceedings against Eduardo Martinez Romero would be a test of a new emergency plan for extraditing alleged top narcotics traffickers. Martinez is wanted in the U.S. in connection with the laundering of huge amounts of cocaine profits. He is one of twelve on a list of leading drug suspects the U.S. wants extradited to this country. The list was provided to the Colombian government today by Attorney General Dick Thornburgh. At the State Department, a spokesman explained the extent of U.S. cooperation with the Colombian government in the Martinez matter.

RICHARD BOUCHER, State Department: We are consulting with the government of Colombia on the best way to bring this money launderer for the Medellin Cartel to justice in the United States. Although Martinez is not a major figure, we are pleased with his capture can look forward to bringing the major kingpins before the U.S. criminal justice system.

MS. WOODRUFF: Martinez was arrested Sunday in a raid on the town of Talu, 425 miles north of Bogota. His was one of almost eleven thousand arrests of people suspected of drug activity. The raids included the capture of an estate owned by Gonzalo Rodriguez Gotcha, a leader of the Medillin Cartel. Colombian television newscasts showed troops invading the palatial compound. They found a private zoo with an assortment of exotic animals, a modern gymnasium with weightlifting equipment and gold faucets in the bathrooms. White House officials said today the President spoke by telephone last night with Colombia's president. A spokeswoman said the U.S. remains ready to provide training, research and other assistance short of military help which she pointed out the Colombian president has not asked for. Robin.

MR. MacNeil: Poland's parliament scheduled a historic vote for Thursday for confirmation of Tadeusz Mazowiecki of Solidarity as prime minister. Mazowiecki met legislative leaders in preparation for the vote where he's assured enough support even without Communist backing. The Communist Party has demanded more cabinet posts than the two offered by Solidarity to join the coalition, but Mazowiecki and the Communist Party leader in Parliament emerged smiling from today's meeting. Asked how the meeting went, both said, "You can see by our faces." In the Soviet Baltic Republics, hundreds of thousands of protesters are expected to demonstrate tomorrow for greater autonomy from Moscow. Robert Moore of Independent Television News has this report from Estonia.

MR. MOORE: The pressure for greater independence from Moscow is mounting in the Baltic Republics. Political meetings are taking place throughout the region on the eve of the 50th anniversary of the Soviet Nazi pact that led to the annexation of these once independent countries. While the majority called for autonomy, the founding congress of a new movement today ended in Latvia. Here the demand was for outright and immediate independence. Speakers called for the Red Army to end what they called its occupation of their land. Many ethnic Russians who now live in the Baltics have met to protest at such talk. They say independence would mean political disaster for them. Here in the Latvian capital, Rega, the Russian music and singing a symbol of their defiance, ethnic differences making talk of independence no simple matter, and in neighboring Estonia, nationalist passions are running just as high. Thousands signed petitions for a referendum on the question of leaving the Soviet Union. Fifty years ago tomorrow, the political tography of the Baltics was overturned. There is now serious debate for the first time in five decades about whether these Baltic states will once again enjoy independence.

MR. MacNeil: The Soviet Union said today that 200,000 of its citizens are expected to emigrate this year and 2 million will make visits abroad because of easier travel restrictions. The Soviet visa agency approved 1.7 million visa applications for foreign travel in the first half of this year, three times the number for all of 1987. The agency said fewer than 1 percent of applicants were turned down, almost always for secrecy reasons. Most of the emigrants chose to go to the United States or West Germany.

MS. WOODRUFF: In Beirut, Lebanon, 4 more people were killed, and 50 wounded in continued shelling overnight following the Christian commander's offer to talk peace with the Syrians. There has been no responsefrom the Syrian government, but its allies among the fighting militia rejected the offer. Meanwhile, France dispatched two more warships to the Eastern Mediterranean, bringing the total number to eight. The French have said their purpose is to evacuate some 7000 French nationals in the country if necessary.

MR. MacNeil: In South Africa, police used whips, tear gas and rubber bullets to disperse demonstrating schoolchildren as anti- apartheid protests grew. The schoolchildren clashed with police in Johannesburg. Police arrested 113 hospital workers staging a protest in Cape Town. They were all part of a national campaign started three weeks ago to protest next month's segregated elections.

MS. WOODRUFF: Huey Newton, one of the founders of the black liberation group, the Black Panthers, was found shot to death today in Oakland, California. The body of the 47 year old Newton was found early this morning lying in a pool of blood on an Oakland street. Police aren't saying if they have any suspects. Newton helped found the now defunct Panthers in the 1960s, and had since been in and out of jail on a variety of charges.

MR. MacNeil: There was more evidence today that the economy is slowing down. The Commerce Department reported that factory orders for big ticket goods ranging from washing machines to warships fell 1.9 percent in July. That was the lowest level in nine months and the fourth drop this year. Today's report came as members of the Federal Reserve Board met in Washington on whether to lower interest rates to stimulate economic growth.

MS. WOODRUFF: Astronomers got a bit of a surprise today from picture sent back to earth to the planet Neptune. Images taken by a camera on the spacecraft Voyager II show a faint but complete ring around the planet which is some 4.4 billion miles from earth. Many astronomers had believed Neptune had a series of only partial rings around it. These pictures are the first of what are expected to be spectacular images of the distant planet taken over the next several days. We'll have more on Voyager later in the program, but first, new questions over the safety of generic drugs, and a documentary report on mismedicating the elderly. FOCUS - RX - SAFE PRESCRIPTION?

MS. WOODRUFF: First tonight we look at the generic drug scandal that has rocked the Food and Drug Administration and raised questions about the safety and effectiveness of generic drugs and how they are regulated. Generic drugs like generic brands in super markets have been hailed by consumers as a way to keep costs down. A generic drug is a discount version of a name brand drug. Both use the same active ingredient. Today 1/3 of all drugs sold in the Country are generic. The Generic Drug industry claims it offers the same quality as brand name drugs at substantially lower prices but that claim into serious question recently when Justice Department investigations revealed that FDA inspectors took bribes from Drug Companies and that some generic drug companies substituted brand name drugs for their own generic brands in FDA Laboratory tests for approval. The criminal investigation has raised questions about the adequacy of FDA oversight of that process. To prevent these problems from reoccurring the FDA has added 18 million more dollars for field operations, intensified surveillance of generic drug companies, appointed an ombudsman to review complaints and to report directly to the FDA Commissioner and announced that leading drugs like pain killer Ibuprofine and anti biotic penicillin will be tested to guarantee their safety. Withus now to discuss the generic drug situation is Dr. Frank Young the FDA Commissioner. He is joined by Congressman John Dingell Democrat of Michigan. He is the Chairman of the House Energy and Commerce Committee. His Committee has held hearings on generic drugs and his work led to the criminal investigations now under way. Dr. Young let me begin with you. Congressman Dingell's Committee started looking into allegations of corruption in the FDA in the generic drug industry over a year ago. Why has it taken so long to begin to pin down specific wrong doing?

DR. FRANK YOUNG, FDA Commissioner: One of the things that was most difficult and appropriate is Mr. Dingell's investigations went forward is that this went directly as investigations in the Sub Committee and by the Inspector General. We were asked to stay outside of this to not interfere and we really got the information when Mr. Dingell brought it to our attention through the hearing process. I want to compliment him very strongly for a good bi partisan work. And as we got the information on this we have gone vigorously to action.

MS. WOODRUFF: Well even before his committee got under way we understand there were complaints from some generic drug companies about other companies about the performance of some of your FDA Employees and we talked to some of those companies today and they told us there was no response from the FDA back when they made those complaints.

DR. YOUNG: Regretfully the division of generic drugs is four divisions removed from the COmmissioners office. It is way down in the bottom. It is 80 people out of 7500 people within the Agency. And as Mr. Dingell found out in the hearing some of those complaints were known they sure weren't known up the line and they were held pretty much in the divisions and the office structure. They did not come to our attention unfortunately until the information began to break.

MS. WOODRUFF: Well that is what I wanted to ask you when did you begin to suspect that you had a real serious problem on your hands?

DR. YOUNG: I knew we had a real serious problem when Mr. Dingell's investigation started and there was a real move to investigate one particular person Mr. Chang. At that point it was an allegation. As we can into the Spring of 1989 more and more facts began to be seen. As each person was identified they were removed from the agency and even before that as they were identified they were put on administrative leave. We did one investigation ourselves but regretfully without having quite the tips that Mr. Dingell had and the Inspector General had we didn't get to the bottom of it.

MS. WOODRUFF: Well let's be specific how wide spread a problem is this. How many FDA employees are we talking about? How many generic drug companies are we talking about?

DR. YOUNG: We are talking about 3 FDA employees that have plead guilty to accepting gratuities out of 7500. I have been impressed in balance with the excellent quality of the large majority of FDA employees who were just as outraged and just as angry as I am in seeing this betrayal of public trust.

MS. WOODRUFF: And the number of companies?

DR. YOUNG: The number of companies are over 300 and the companies that have been indicted this far, that have plead guilty are essentially three and we have investigations on in 11 we are going to widen that.

MS. WOODRUFF: Congressman Dingell is that a fair representation of the extent of this wrong doing?

REP. JOHN DINGELL, [D] Michigan: Well before I start in to tell you that I would like to say that I have great deal of respect for Dr. Young. Having said that I have to say I have to say there are great problems here and they take many forms. There is an industry quite honestly that has huge amounts of money at stake and has gone to unscrupulous lengths in many instances to achieve the huge economic advantages that one can get buy getting an abbreviated new drug application successfully processed. There were substantial amount of misbehavior inside the FDA at the Division of generic drugs. There was a budget shortage, there was a climate of deregulation in the Administration, there was lack of cooperation with the Committee by personal particularly in the General Counsels Office at FDA. There was a refusal of FDA Officials to hear the complaints that were coming from persons in the industry who were pointing out that there was not only criminal misbehavior in the sense that they were taking money for this but also misbehavior in the sense that special preference or special adversity were given or imposed on particular applicants.

MS. WOODRUFF: So Commissioner Young you heard what the Congressman is saying that it wasn't just the small office of generic drug approval.

REP. DINGELL: No we are only talking about the office of generic drugs at this particular moment.

MS. WOODRUFF: I thought you mentioned the General Counsel?

REP. DINGELL: The General Counsel has to be ultimately be dismissed because quite honestly he engaged in some serious misbehavior.

DR. YOUNG: But the office I need to say this very clearly we are talking about an office of about 80 people that really focused on this. Our inspectors have been turning the nation up side down we've got 30 of the top generic drugs we are looking at. We've got over 1500 samples were are dealing with. It is the reviewers not the inspectors that was mentioned in your earlier case that we know of at this time.

REP. DINGELL: It does go beyond this in an very interesting way.

MS. WOODRUFF: Goes beyond what?

REP. DINGELL: Goes beyond what is being described by Dr. Young. What was going on was there was special preference given to some and special difficulties imposed in the paths of others. That is every bit as criminal as taking money and that was wide spread in this particular division.

MS. WOODRUFF: But he said there were only three employees dismissed?

REP. DINGELL: Well there is going to be a couple more indicted and there is going to be a goodly number of additional people in the industry that I think will be ultimately be indicted. There is evidence of substitution of the innovators drug for the generic drug that was supposedly being tested. Quite honestly I have to say that I have always been a great advocate of the use of generic drugs to save money to the patient. Save money to the tax payers in connection with Federally financed programs but I can no long vouch for the safety of generic drugs that have been approved under this particular program under this Agency.

MS. WOODRUFF: That is a very serious charge what do you mean by that?

REP. DINGELL: It is a very serious statement.

MS. WOODRUFF: I mean what do you mean by that. I mean, you can no longer vouch for the safety?

REP. DINGELL: I mean just exactly what I say. I do not believe that these matter have been handled to the point where we can now be sure that these drugs are in fact the full equivalent of the innovators drugs that they are supposed to replace and I can not give any assurance that any of them, in fact, do function in the body as they are supposed to.

MS. WOODRUFF: Dr. Young do you want to comment on that?

DR.YOUNG: I think that the Chairman and I are saying in part many things that are the same. First we have immediately have reorganized and moved the generic division to an office and are out there right now inspecting the 30 brand name drugs that are in generic equivalence and within 12 weeks we will know and be able to answer Mr. Dingell's question.

REP. DINGELL: I don't think that is true because I don't think that you are going to be able to go through the entire roster of these drugs. Some of them you are going to go through but your tests are not being as complete with regard with the original abbreviated drug application.

DR. YOUNG: There is no question that it is a more abbreviated application but I think that we can get a good deal of information with that.

REP. DINGELL: And there is another thing about it. There is a lot of these drugs still on the market that are marketed by some of the scoundrels that had engaged in these practices and they have not been taken off the market.

MS. WOODRUFF: You mean some of the same drugs and other drugs?

REP. DINGELL: The same drugs and other drugs are still on the market.

MS. WOODRUFF: What about that Dr. Young?

DR. YOUNG: We have today began today to remove through administrative processes some of these ANDAs.

MS. WOODRUFF: I am sorry what is an ANDA?

DR. YOUNG: This is the abbreviated drug application that the Chairman is speaking too. We are looking to use our authorities to the maximum and the plan announced by Dr. Sullivan we are going to obtain additional authorities to augment that we have in the Food and Drug Administration to use our capabilities to remove product from the market when products are found to be obtained in the fraudulent process. Now when there is any safety problem we can take those off immediately.

MS. WOODRUFF: That is what I want to get back to. Congressman Dingell has made a very serious charge that he is saying he doesn't believe that FDA can no longer guarantee the safety of a certain number of generic drugs. Should consumers out there who are taking certain generic drugs be concerned right now. Do they have reason to be worried?

DR. YOUNG: I think the reason there is a major problem right now is we found flaws in the way that the applications were approved. We have not have found any evidence of safety problems. We too have safety concerns but I would not in any way at this point tar with a brush the large number of generic firms that really ethical but I can not at this moment distinguish at this moment exactly what is what.

MS. WOODRUFF: You think the large number are ethical?

REP. DINGELL: I can not make that statement. The problem that you have is there was fraud, bribery, substitution in connecting with this, false reporting, there was serious misbehavior on part of the many drug houses that were involved in this. There was serious behavior inside the agency. Now how many of these if you have as much of this as you have the question is where does it end. I don't know.

MS. WOODRUFF: Where does it end Doctor Young?

DR. YOUNG: That is exactly why we have the plan that is going to be focused on now. Let me just spend a moment on it. We are out there now looking at the top 300 companies, the top 30 generic copies those constitute 76 percent of all generic drugs. Tomorrow I am going to go up and inspect our laboratories that are doing this work and in about 12 weeks we will not what is going on. We are increasing our inspections of the firms.

MS. WOODRUFF: But as you said earlier only three companies have been directly implicatedso far. How many more do you believe might be involved, I mean, might it be many many more or is most of the industry going to turn out to be clear. I mean can you say with any confidence at this point?

DR. YOUNG: At this point based on what we know from already having looked at 2000 drugs each year we feel that the majority of the industry is likely to be safe and effective and would put it in that category highly likely to but we are not going to rest until we know the answer to that and that is where I would associate myself with the comment made by the Chairman that because of some of the problems that this industry has stooped to, I mean, after all it has given gratuities to federal employees, it has substituted the brand name drug in the capsules of their own and submitted it falsely. It is falsified data but so far there is a limited number of companies and we are not going to rest until this is rooted out.

REP. DINGELL: These are not the only problems. Quite honestly this all occurred against a background in an administration which sought to deregulate, which believed in the kind of regulation that Dr. Young would like to see.

MS. WOODRUFF: You are talking about the Reagan Administration.

REP. DINGELL: I am talking about the Reagan Administration but you have to remember that this is carrying over in to this administration because the same general philosophy is here. And he had massive budget cuts. That is wrong he needed more rather than less.

MS. WOODRUFF: You are saying that he didn 't have adequate money to police this?

REP. DINGELL: Neither adequate money nor adequate personal because he got huge budget cuts there. He has a statute that has not really been looked at the Congress for years and we are going to have to take a look to see whether the statute affords the FDA, Dr. Young the ability to deal with the problems that he has to address.

MS. WOODRUFF: Does Congressman Dingell have a point there Dr. Young about why all this, there was a climate that permitted all this to take place?

DR. YOUNG: I think there is no question that the Food and Drug Administration has had some cuts. That is clearly evident, however I must say that I have been very pleased with the action that has been occurring in the last few years. Congressman Dingell himself testified before the Budget Committee on FDA resources. The Secretaries have increased our resources and I think we are addressing this thing.

MS. WOODRUFF: Well let me ask you why do you think it has happened at the FDA and you after all have been Commissioner for the last 5 years.

DR. YOUNG: Let me focus on it this way. We have a very difficult time today in Government. The salaries particularly in the regulatory agencies are very difficult to recruit people for. This has been widely addressed. We have difficulties in having an FDA that is in 23 different places. We have an agency that is overwhelmed by crisis. If you look at this year we went from dealing with blood banks problems to the Chilean Grapes and we move resources from place and the final thing I would say is that is a Scouts honor system as it was constructed by the Congress as the laws went forward we were told and instructed to go to an abbreviated process and we rolled forward what was tried and true for years.

MS. WOODRUFF: Sounds like a plea for more money.

REP. DINGELL: He is absolutely right on the need for more money and that is part of it but basically you have to have a philosophical change inside the Government and inside FDA. You also have some very real problems have to address. Dr.Young and his people go off to look at Chilean Grapes or blood banks or things of that kind they have a big problem but that is like pulling the cat away from the cheese in a cheese factory. Then the mice and rats come out and celebrate greatly. The problem we've got now is that you have here an industry where there is 40 to 60 million dollars a year available to wrong doers to bribe to get that first years advantage on generic.

MS. WOODRUFF: This is one that I know we will come back to. Gentlemen we thank you both for being with us. Congressman Dingell, Commissioner Young. Robin. MISMEDICATING THE ELDERLY

MR. MacNeil: Next we look at another problem involving prescription drugs, mismedicating the elderly. Each year, an estimated 250,000 elderly Americans are hospitalized for complications resulting from the use or misuse of prescription and over-the-counter medicines. We have a report from Fred Sam Lazaro of public station KCTA Minneapolis-St. Paul.

FRED SAM LAZARO: It's been called the nation's other drug problem. Every year 1/4 million elderly Americans are hospitalized for adverse reactions to prescription or over-the-counter drugs. The elderly account for more than half of all deaths from drug reactions. They make up just 17 percent of the total population. 81 year old Belle Farrington took home what she thought was a routine prescription a few months ago. It started a lengthy mismedication nightmare that severely disabled and nearly killed her.

BELLE FARRINGTON: My mouth was all crooked. My eyes had this infection and I couldn't walk and I remember being very embarrassed. I didn't want anybody to see me.

MR. LAZARO: Farrington's problems began about a year ago. She complained to her doctor that a cardiac problem she was being treated for was causing her anxiety. In addition to heart medicine she was given drugs to relieve the anxiety, but her condition worsened. Among the symptoms was a mental incoherence. Farrington's daughter, Ruth Weiby, is convinced it was a side effect of the new drugs.

RUTH WEIBY, Mrs. Farrington's daughter: It was there in bold letters that these are the side effects that you must watch out for and if they start to occur, you must remove this medication.

MR. LAZARO: But Ruth Weiby says doctors, instead, prescribed more anti-anxiety medicine for her mother. Worse physical and mental symptoms followed, prompting a new regime of anti-psychotic drugs. Finally, her daughters were advised to place Farrington in a nursing home, the diagnosis, Parkinson's syndrome, a slow, degenerative, nervous system disorder.

ROSE BURNS, Mrs. Farrington's Daughter: I have read up on a little bit about these medications and there are some severe side effects and one of them is that you become very shaky, involuntary motions, and even develop Parkinsonian symptoms which did happen to my mother.

RUTH WEIBY: We reiterated that fairly frequently and they didn't believe us. When it came time to release her from the hospital, they gave me this handful of prescriptions that I was supposed to go and fill and on the very top one was the same medication that had put her in the hospital in the first place, and I took one look at that and I threw it down and I said, she's not getting this. She'll never get any of this again. And I was just furious.

MR. LAZARO: The abrupt removal of a complex battery of drugs caused severe withdrawal problems for Belle Farrington, but a new clinic that took over her treatment confirmed she'd been badly mismedicated. It was months before Farrington could return to a normal life.

DR. IRVINE: Drugs act a little different in the elderly than they do in younger people.

MR. LAZARO: Minneapolis gerontologist Patrick Irvine says many drugs are initially tested on the young and healthy. They are prescribed for elderly, less healthy people with very different metabolisms.

PATRICK IRVINE, Gerontologist: Older people in general may lose up to 50 percent of renal function as they approach 80 and 90 years old. And those drugs that are eliminated principally by the kidneys then are more subject to accumulation in these people.

MR. LAZARO: Common sense, it may seem, to use common sense in prescribing drugs to a medically fragile population, but many doctors, themselves, admit they know much less than they should about prescribing to this group. In fact, in one recent Temple University, 70 percent of doctors failed a test on medicating the elderly.

DOCTOR: [Talking to Patient] You know, Alice, when you came here you were on four different medications, and now we've been able to get you down to just one.

MR. LAZARO: One reason for the apparent lack of knowledge or interest could be a lack of financial incentive. Dr. Eric Tangalos, Medical Director for a Rochester, Minnesota nursing home says insurance companies pay doctors much more for procedures like exams or surgery. On the other hand, he says doctors who treat large numbers of elderly people spend much more time consulting with their patients. They receive Medicare's lowest reimbursement.

ERIC TANGALOS, Medical Director: The absolute bottom so that the amount of time that the physician spends with the patient, the amount of cognitive effort that goes into it is reimbursed at the lowest rate possible.

DR. IRVINE: It's much easier to write out a prescription for a medication and have the person go home than spend another 20 minutes or 30 minutes in the office trying to sort out exactly what it is that's wrong with that patient and maybe go without a medication.

MR. LAZARO: Helen Seidl recently brought her husband back home shortly after placing him in a nursing home. She's convinced he'd have died had he remained much longer.

HELEN SEIDL, Robert Seidl's Wife: He was there about maybe 10 days when I was called one morning at 7 o'clock in the morning that he wasn't responding and that they had already called the paramedics and they asked that I come down. He was just perfectly limp, like a person who might have had a stroke.

MR. LAZARO: Robert Seidl actually suffers from Parkinson's Disease, but his strokelike symptoms had nothing to do with Parkinson's.

MRS. SEIDL: When they examined him thoroughly, the doctors told us that it was a case of overmedication.

MR. LAZARO: Helen Seidl says her husband had an adverse reaction to sedatives he was given that morning, drugs that also had nothing to do with Parkinson's syndrome.

MRS. SEIDL: There were many days when that nursing home was short of help and they would not be able to take care of him even as to getting him up and cleaned up before afternoon and that maybe it was used just to keep a patient quiet until they could get to them.

MR. LAZARO: Helen Seidl's suspicions are well founded. Sedatives and behavior control drugs are commonly administered in geriatric populations, the practice is a major cause of mismedication.

DR. IRVINE: At some particular nursing homes, places where there are too few nursing staff, that we are asked and sometimes put under some pressure to use medications to control behavior, to make a person more malleable, to help them blend into the setting and to adjust.

DR. TANGALOS: The problems of combative patients is really where we get into trouble, deciding what's right for the patient, what's right for the rest of the patients in the facility and what's right for the staff. We have patients who hit people. You've got to decide where is the risk greatest.

MR. LAZARO: While doctors in some situations have to take steps that increase the risk of mismedication or overmedication, Tangalos says there are other ways in which risks can be reduced, among them more cooperation between people who care for the elderly.

DR. TANGALOS: If I'm able to call the pharmacist, when I need the pharmacist, or the pharmacist is not afraid to call me and interrupt me during my day, then we're better off.

MR. LAZARO: For his part, Howard Juni of the Minnesota Pharmaceutical Association, says new technology is now making the job of reviewing medication much easier.

HOWARD JUNI, Pharmacist: If I'm filling a prescription for you today or next week or next year and there's a possibility that you might be allergic to that drug or an ingredient in that drug, the computer stops and alerts the pharmacist that there may be a potential problem. It also will screen a new prescription that you bring in against other prescriptions that you've gotten in the past.

MR. LAZARO: Assuming, of course, that the previous prescriptions came from the same pharmacy. If they didn't, Juni says it's important that patients tell the new pharmacist or especially a new doctor what drugs they are taking and for how long. Gerontologist Irvine says consumers or their guardians must be involved in health care if mishaps are to be avoided.

DR. IRVINE: Sometimes older people are their own worst enemy when it comes to medications. They often are seeking medication when they come to see the physician, and they make us feel that if we're not, if we're a good physician, we'll give them something, and they may not come back if we don't prescribe something. Two, they aren't assertive enough with respect to the medications we give them. They don't ask us what are the side effects, what do I need to look for.

MRS. FARRINGTON: they should be willing to explain why they're doing what they're doing.

MR. LAZARO: Belle Farrington says doctors too must be open to change in their relationship with patients. In her case, she says they were not.

MRS. FARRINGTON: We older people, especially, have a tendency or did have, we're getting educated out of it, but we did have a tendency to feel that whatever the doctor said went, and that you really didn't question them, and often the doctors don't want to be questioned. They don't take it kindly.

MR. LAZARO: Just as patients like Farrington are becoming more educated, health care experts say providers are growing more aware of the dangers of drug misuse in the elderly. One reason, the federal government, the biggest insurer, is beginning to require drug utilization review for Medicare recipients. Also, there are simply more older people today. Their numbers are increasing and so is their life expectancy. Drugs have played a part in that. Used properly, they will have a bigger role in improving the quality of that longer life.

MS. WOODRUFF: That report by Fred Sam Lazaro. Still ahead on the Newshour, a special look at the 12 year old Voyager mission. But first, this is pledge week on public television. We're taking a short break now so that your public television station can ask for your support. That support helps keep programs like this on the air. FOCUS - FANTASTIC VOYAGE

MR. MacNeil: Finally tonight the 4 billion mile flight of the spacecraft Voyager to the planet Neptune. It will make its closest encounter with the planet Thursday night. Since 1977, when two Voyagers were launched, pictures have been sent back of the four outer planets. Special Science Correspondent Tim Ferris went to the jet propulsion laboratory in Pasadena where the pictures are enhanced and studied to find out what has been learned.

TIM FERRIS: Neptune is a mystery, the last great unknown planet in the solar system. Now that's changing. The Voyager II space probe is rapidly closing in on Neptune and images transmitted back to earth by the unmanned craft already show a wealth of previously unseen detail there. Four new moons have been discovered orbiting Neptune as well as spectacular cloud patterns adorning the outer atmosphere of the giant gaseous planet. Much more is expected by Thursday night when Voyager will make a daring plunge to within only 3000 miles of the cloud tops of Neptune. If its cameras and scientific instruments do their work properly, more will be learned about Neptune in the next few days than in the century and a half since the planet was discovered. Voyager II is already something of a technological legend, a heroically tough and versatile spacecraft that has managed to reconnoiter all four of the giant planets that dominate the outer solar system in the course of a 4 billion mile odyssey through interplanetary space. This full scale mock-up of Voyager looks brand new, but the real space craft is as battered as an old used car. Its surface has been pelted by micro meteorites, its main radio receiver failed more than a decade ago, and the back-up is so unstable that engineers have to guess at which frequency to send it commands. This is the now famous camera scanning platform. The one aboard Voyager II has developed a chronic case of arthritis. Consequently, it will sometimes be necessary to swivel the entire spacecraft so that its cameras can track Neptune and its moons. Its a potentially hazardous maneuver that causes a temporary loss of contact between Voyager and the earth. But despite all these difficulties, the engineers and scientists here at the jet propulsion laboratory which controls Voyager express confidence that this old spacecraft can be expected to perform its one last mission and delivery a bonanza of discovery from the remote planet Neptune.

BRAD SMITH, Voyager Team Leader: It's essentially changed our whole view of the outer solar system. When we go out and look at Jupiter, and even more so as we go further out to Saturn and Uranus and Neptune, we're seeing material which is more like that nebula that collapsed to form our solar system. It's telling us that there was a lot of organic chemistry in that early solar system and at some point there are questions bearing on the origin of life that the study of that primitive material is addressing.

MR. FERRIS: Every journey through space is also a journey through time, and the Neptune encounter marks the climax of a 12 year tour of the outer solar system. When Voyager II and its twin, Voyager I, were launched, it was the summer of 1977, the year when a massive electrical failure plunged New York City into darkness and the Oakland Raiders won their first Super Bowl championship. By the time the Voyagers reached the planet Jupiter, it was 1979. Back on earth, the Shah of Iran was being driven from office and a reactor failure at Three Mile Island raised new doubts about the safety of nuclear power. The Voyagers sent back photographs and data that revealed a symphony of small scale chaos and global order in Jupiter's hydrogen and methane atmosphere.

BRAD SMITH: A pretty picture is a pretty picture, and some of the scenes that we've seen, the swirling storms on Jupiter, it isn't just scientifically interesting, it's a pretty picture. It's the sort of thing you want to take and put up on your wall and just sit there and look at it.

MR. FERRIS: The wildly diverse faces of Jupiter's moons were studied as well. The icy crusts of Ganamen and Colesto are thought to preserve materials that have changed but little since the sun was born. Cracks in the surface of Europa suggest that rivers of liquid water once flowed there. The most startling of Jupiter's moons proved to be little Eo, a Danteesque world only 1000 miles in diameter where volcanoes more powerful than the one that devastated Mount St. Helen's erupt from lakes of liquid sulfur. From Jupiter, the Voyagers continued on to Saturn. In 1981, earthly television carried images of the assassination of Egypt's president, Anwar Sadat, and the wedding of Prince Charles and Lady Diana in St. Charles Cathedral. The Voyagers, meanwhile, were revealing that Saturn had not three or four rings as had been thought but thousands of rings etched with ghostly looking tendrils of dust due perhaps to the impact of meteors on Saturn's vast ring system.

CAROLYN PORCO, Voyager Scientist: By examining these disk systems, which is what they are, they are flat disk systems, we can learn a lot about the way the solar system was formed and how it came to evolve from more or less a spherical cloud of dust and gas, collapse into a disk, and from there form planets, which is the way we believe things happened. Well, you can think of planetary ring systems as being in an arrested state of development, and so by examining a planetary ring system like Saturn's, you can learn a lot about what probably went on when the solar system was forming.

MR. FERRIS: Studies of Saturn's atmosphere where a thousand mile per hour gales waft through cloud banks larger than North America added new chapters to human understanding of the weather on other planets.

ELLIS MINER, Voyager Scientist: We don't have any land forms on these giant planets, so we can observe storms over long periods of time as they develop and as they build and grow and swallow up surrounding storm features, and it's just a system without land. We can study the meteorology much more clearly in such a system and perhaps apply that meteorology to earth eventually.

MR. FERRIS: The Voyager took hundreds of photos of Saturn's moons. The most mysterious is Titan, a possible abode for life.

ED STONE, Voyager Scientist: Titan has an atmosphere 60 percent higher pressure than that here on earth, mainly nitrogen like that here on earth, but with methane rather than oxygen, so the photochemistry going on there today may be closely related to the kind of photochemistry that went on early in the earth's atmosphere before life evolved.

MR. FERRIS: Voyager I ended its mission at Saturn climbing up out of the plane of the solar system, but Voyager II continued outward toward a rendezvous with the planet Uranus. It arrived there in 1986, the year that the space shuttle Challenger exploded, killing all seven aboard and paralyzing the American space program. Voyager charted the rings of Uranus and photographed the curiously bland face of a planet that has somehow been tilted on its side perhaps as the result of a collision with an enormous comet. It explored the jagged canyons of the Uranian satellite Miranda. Ahead lies Neptune. Voyager's encounter with Neptune will mark our last first look at a giant solar planet.

MS. PORCO: We have seen every major planet in the solar system. Our race has visited for the first time every major planet and never again will we approach a planet like Neptune from the state of ignorance and innocence that we currently find ourselves in, so it is a great great special moment as this encounter comes to an end.

ED STONE, Voyager Scientist: We believe that the inside of Neptune is probably half water ice, actually melted water ice, and half rocky material, which came in as cometary material, accumulated comets, which slowly but surely added up to make a planet, and on the top the outer 20 percent is mainly hydrogen and helium with some 2 or 3 percent methane and a few other trace constituents. And what we see when we look at Neptune are clouds of methane ice. The water ice clouds are hidden from view below several other cloud decks. This planet is about four times the diameter of earth.

MS. PORCO: The burning question is why does Neptune have ring arcs and not a more extensive ring system like Saturn? In fact, we are really puzzled by the variety of ring systems seen in the outer solar system, and that's something we scientists like to do is to find a common thread that connects different physical systems, so we are going to be looking at what characteristics Neptune's ring system and Saturn's ring system and all the other planetary rings have in common and what makes them different.

MR. SMITH: Neptune is turning out to be just an extraordinarily interesting object, the planet, its ring arcs, satellites, so we're going to go out for a big push, a big push for science, and that just has to make us feel really good.

MR. FERRIS: One thing scientists will be looking for is a chance to focus Neptune's curious moon, Tritan.

MR. SMITH: Tritan is a mysterious object. It's going the wrong way around Neptune. It couldn't have formed that way. It's had to have undergone some terribly catastrophic process at some time in the past, and the hope is, of course, that something that we see on the surface will tell us about that catastrophic process, so we'll be intently looking at the surface when those high resolution images come in.

MR. FERRIS: When it leaves Neptune behind, Voyager will drift out of the solar system to wander among the stars forever. Voyager's first inter stellar encounter will come in 40,000 years, when it passes within two light years of a red dwarf star listed prosaically in the catalogues as Ross 248. Just in case it should one day be found by an alien civilization, it carries a permanent record, a phonograph record, bearing music, sounds of earth, and over 100 photographs of our world and its inhabitants. We don't know, of course, whether human music and photographs would mean anything to a non-human space farer, but any intelligent creature who came across Voyager could recognize that the record had been dispatched without hope for return, and that gesture may speak most eloquently of all. The Voyager record says that no matter how primitive we were or how crude this spacecraft, we knew enough to think of ourselves as citizens of the cosmos. It says that however small we were, something in us was large enough to want to reach out into the distant future when our species will have perished or have changed beyond recognition. It says to our fellow residents of the galaxy that whoever and whatever you are, we too once lived in this house of stars and we thought of you. RECAP

MS. WOODRUFF: Again, the main stories of this Tuesday, Colombian officials began proceedings to extradite the finance chief of a major drug cartel to the U.S. and in Poland, a vote was scheduled for Thursday to confirm a Solidarity leader as the new prime minister. It will be the first non-Communist government in Poland in 45 years. Good night, Robin.

MR. MacNeil: Good night, Judy. That's the Newshour tonight and we'll be back tomorrow night. I'm Robert MacNeil. Good night.