Why Doctors Pile on the Pills
Report urges doctors to think harder about side effects, alternatives.
We’re not anti-medicine by any means, but it seems safe to say that medicine as practiced today involves a lot of overprescribing and underprescribing. Oxycontin, for example, is prescribed both too often and not often enough. The more addicts buy their way to prescriptions, the more legitimate pain sufferers are put under added scrutiny and supplies are tightened. Dr. Lisa Schwartz of Dartmouth Medical School told Reuters Health that overprescribing goes “hand in hand” with underprescribing of drugs to high-risk patients. "We have both problems in this country," Schwartz said. A recent think piece in the Archives of Internal Medicine concentrated on the problem of overprescribing only, but managed to come up with several common sense proposals that every prescribing physician should consider.
"Instead of the latest and greatest,” Dr. Gordon Schiff, of Brigham and Women's Hospital in Boston, told Reuters Health, “we want fewer and more time-tested drugs." Almost half of all Americans have taken a prescription drug in the past month, according figures from the U.S. Centers for Disease Control and Prevention. About four million prescriptions for opioid drugs are written every year.
What would help? Schiff and co-workers offer a number of specific suggestions:
- Think Beyond Drugs: Prevention and underlying conditions are important, too.
- Strategic Prescribing: Avoid unwarranted drug switching, and start treatment with only one new drug at a time.
- Adverse Effects: Monitor for possible drug interactions, and be aware of withdrawal syndromes.
- Caution With New Drugs: Seek out unbiased data, and be wary of selective drug trials.
- Shared Agenda: Work with patients on issues of noncompliance, respect patients’ reservations about drugs, and discontinue unneeded meds.
Schiff doesn’t let patients off the hook, either. "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."