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US doctors too quick to prescribe

14th June 2011

A new report contends that doctors in the United States are too ready to prescribe drugs for their patients, with scant concern for side-effects or non-drug alternatives.

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The report, titled "Principles of Conservative Prescribing", was funded by government grants supporting consumer healthcare education and healthcare quality research.

It urged medics to prescribe fewer drugs, and to use those had had stood the test of time.

Study author Gordon Schiff, of the Centre for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston, said the report aimed to promote a different way of thinking about how medicine is practised in the US.

The US Centers for Disease Control and Prevention (CDC) found that almost half of Americans had used at least one prescription drug in the past month.

Overprescribing is widespread, throughout the healthcare system, according to healthcare best-practice experts.

The impact on patients translates into regular exposure to unnecessary side-effects, some of which can be fatal.

Schiff said many conditions would benefit from lifestyle changes like exercise programmes, physiotherapy or a new diet.

Doctors are often quick to reach for their prescription pad because the consultations are often short and rushed.

Patients and doctors alike are bombarded with television advertisements for pharmaceutical products, many only available on prescription.

What's more, Schiff said, pharmaceutical sales representatives visit doctors' offices regularly to persuade them to use new products.

No-one puts that level of effort into promoting non-drug treatments like diet and exercise.

Not all prescription medications are effective or useful, the study said. For example, opioid painkillers like Vicodin and Percocet are increasingly prescribed to patients amid sparse evidence of a long-term improvement in patient well-being.

An editorial in the same journal said that there was plenty of evidence to show that the painkillers did harm to patients.

Deborah Grady of the University of California, San Francisco, and her colleagues found that there were nearly 11,500 deaths linked to prescription opioids, larger than the deaths linked to heroin and cocaine put together.

US doctors hand out around four million prescriptions for long-acting opioids annually, although side-effects include constipation, sleepiness and addiction.

The report said that newly developed drugs were often tested on young, healthy people, and their effects on older, sicker patients were often unknown.

Clinical trials also often involved only a few thousand patients, they said.

Doctors are not always aware of what else a patient is taking, posing questions about the safety of too many prescription drugs.

By the time Americans reach 60, one in three of them will be taking five or more drugs.

Doctors say that unbiased information about new pharmaceuticals is hard to come by.

According to Dartmouth Medical School doctors Lisa Schwartz and Steven Woloshin called on the US drug regulator, the Food and Drugs Administration (FDA) to send out summaries to doctors of their assessments whenever a new drug is approved.

They said that often high-risk patients were victims of underprescribing, although the problem of overprescribing did exist as well.

Schiff said patients should ask critical and sceptical questions of their doctors during consultations, learn more about the side-effects of the drugs they have been given, and be on the lookout for problems.



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