Friday, December 16, 2016

U.S. Doctors Still Over-Prescribing Drugs

Despite evidence that certain drugs aren’t always necessary, doctors are still prescribing these treatments, a new survey of doctors reveals.

Antibiotics are by far the drugs most frequently used in situations where they’ll provide no value for patients. The survey found that more than a quarter of doctors surveyed (27%) said that antibiotics are often administered to patients when the drugs will do no good.

In most cases, the antibiotics are prescribed to treat upper respiratory infections even though these are most often caused by viruses unaffected by the medication, said Dr. Amir Qaseem. He’s vice president of clinical policy for the American College of Physicians (ACP) and chair of the ACP’s High Value Care Task Force.

Other treatments that doctors use frequently despite their questionable value include aggressive treatments for terminally ill patients (9%), drugs prescribed for chronic pain (7%), and dietary supplements such [as] fish oil and multivitamins (5%), the survey revealed.

“There is a lot of waste in our health care system, and we need to acknowledge that,” Qaseem said.
The results are from a random survey of 5,000 ACP member physicians. The survey asked doctors to identify two treatments frequently used by internists that were unlikely to provide high value care to patients.

“Value is not the same as cost,” Qaseem said. “High value is a function of the benefits, harms and cost of an intervention all together. Just because something is very expensive does not make it a poor value. There are expensive treatments that provide high value.”

In the United States, a least 2 million people a year are infected with bacteria that are resistant to antibiotics, and at least 23,000 die as a direct result of these infections, according to the U.S. Centers for Disease Control and Prevention.

The study findings were published online Dec. 5 in the Annals of Internal Medicine.

My Take:
The report goes on to say that physicians continue to prescribe antibiotics because of patient pressure, to ward off malpractice suits and because “common wisdom” was that a great deal of upper respiratory infections were bacterial in nature. The second excuse may have some merit, but most physicians are very authoritarian when it comes to prescribing medications, both pro and con. Just look at statin drug prescriptions – as of 2012, 26% of Americans over the age of 40 were taking statins. Common wisdom? I was taught that 90% of upper respiratory infections (UPIs) were viral and that was 40 years ago.

I think most physicians that prescribe antibiotics for UPIs do so because that’s what they’ve always done and who bothers to read or comply with the literature and standards of practice? It’s the same thinking that prevents physicians from ordering an A1c to look for diabetes or from recommending low-dose aspirin to patients that have not had a heart attack.

I agree with multiple vitamins being listed in this report. Multiples are not worth the cost of the label on the bottle. However, compared to antibiotics the “value” not really a consideration – the negative effects are minimal and the cost is small.

I disagree with the additional of fish oil to this report. There are multiple studies demonstrating the benefits of these essential fatty acids. However, there is one poorly designed study that failed to show a direct benefit in cardiovascular disease.

The Bottom Line:
You must be your own health advocate and question the use of antibiotics or any other drug recommended by your physician. Until you demand change, change will not occur.

Source: December 5, 2016 National Institutes of Health

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