U.S. doctors are too quick to reach for their prescription pads, according to a new report urging them to think more about side effects and non-drug alternatives.
“Instead of the latest and greatest, we want fewer and more time-tested drugs,” said Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston, a non-profit organization that studies ways to improve safe practices in healthcare.
“We are really trying to promote a different way of thinking about practicing,” added Schiff, whose report appears in the Archives of Internal Medicine.
Nearly half of all Americans have used at least one prescription drug in the past month, according to the Centers for Disease Control and Prevention, and experts say overprescribing is rampant.
By definition, that means people are being exposed to side effects, sometimes fatal, without the benefits that would justify those risks.
“Often what is really bothering them is not cured with a pill, but rather through exercise, physical therapy, or diet changes,” Schiff told Reuters Health.
Yet many doctors are quick to prescribe a drug, partly because they have limited time to deal with individual patients or because they and their patients have been bombarded with ads from the pharmaceutical industry.
As for prevention and non-drug alternatives, Schiff said, “there are no drug reps coming to my office pushing that.”
In an editorial in the same journal, researchers describe how opioid painkillers like Vicodin and Percocet have become increasingly common without good evidence that they help patients in the long run.
The evidence of harm, on the other hand, is clear, write Dr. Deborah Grady of the University of California, San Francisco, and her colleagues.
In 2007 alone, for instance, there were nearly 11,500 deaths related to prescription opioids — “a number greater than that of the combination of deaths from heroin and cocaine,” according to the researchers.
Some four million prescriptions for long-acting opioids are written every year, with side effects ranging from addiction to constipation to sleepiness.
To counter some of this overprescribing, Schiff and colleagues urge doctors to think beyond drugs and to prescribe new ones much more cautiously.
When it first hits the market, new medicine has usually only been tested in a few thousand patients, often healthier and younger than the ones doctors see in their offices.
That leaves a lot of questions about safety, especially since patients often are taking several drugs at the same time. More than a third of people over 60 take five or more drugs, for instance, and the number of prescriptions continues to rise.
But Dr. Lisa Schwartz and her husband Dr. Steven Woloshin, both of Dartmouth Medical School in Hanover, New Hampshire, told Reuters Health it’s difficult for doctors to get unbiased information about new drugs.
“We need to be making this information much more easily accessible to doctors,” said Schwartz, an expert in risk communication. “There are billions of dollars being spent on new drugs with unproven benefits.”
Schwartz and Woloshin said one way to do this would be to have the U.S. Food and Drugs Administration, which approves new drugs, send out simple summaries about the medications.
They also emphasized that overprescribing, while real, goes hand in hand with underprescribing of drugs to high-risk patients.
“We have both problems in this country,” Schwartz told Reuters Health.
According to Schiff, patients also have a role to play.
“Patients need to ask critical and skeptical questions, too,” he said. “They really should learn about the side effects of the drugs they are taking and be on the lookout for them.”
Schiff’s “Principles of Conservative
Prescribing” study was funded by government grants supporting consumer healthcare education and healthcare quality research.
SOURCE: http://bit.ly/lwuNm0 Archives of Internal Medicine, June 13, 2011.
