PATIENT CARE

Inappropriate Use

of Antibiotics

It’s that sneezing, sniffling, coughing time of year, when Americans flood their doctors’ offices with pleas for help. The remedy patients request the most, in subtle and not-so-subtle ways, according to new research, is antibiotics. That’s despite the fact that the bacteria-fighting drugs do nothing to thwart the viruses that cause colds and the flu. Doctors know this, of course, but sometimes prescribe the drugs anyway to placate patients.

In a study of 298 routine office visits by patients complaining of acute respiratory infections, researchers from New Jersey and Texas identified several behaviors patients used to persuade their doctors to prescribe antibiotics. Some patients made explicit requests, saying that antibiotics had brought them relief for similar symptoms in the past. Patients often diagnosed their conditions, saying something like, “I think I’ve got strep throat” or “It sounds like bronchitis.” Another tactic: portraying their condition as severe and deteriorating rapidly: “I feel,” said one, “like the back of my throat has raw hamburger hanging in it and I just can’t shake it.”

If such overtures didn’t work, the researchers said, some patients tried to provoke guilt. “But I’m going to Disney World,” said one man explaining that his illness might ruin a long-planned family vacation. When his doctor agreed to prescribe antibiotics, the man then convinced him to write out a prescription for his kids even though they had never been seen by this physician.

The tactics usually worked. Antibiotics were prescribed in 68% of the cases. Of those cases, 80% of the prescriptions were later determined to have been unnecessary under guidelines for antibiotic use developed by the Centers for Disease Control in Atlanta. Considering that overprescribing of antibiotics is thought to be one of the main causes behind the rise in drug-resistant germs, researchers suggest that physicians “should be shown techniques” to resist these pressures.

Linda Marsa

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Ads Appear to Have

an Influence on Viewers

Those TV and magazine ads for Claritin, Lipitor, Zocor and other prescription drugs continue to be a focus of controversy.

Critics of the drug industry’s so-called direct-to-consumer ads contend such marketing persuades consumers to demand costlier drugs and drives up prescription drug spending and overall medical costs.

Drug companies contend that the ads are educational and encourage patients to take charge of their health and seek medical treatment for undiagnosed ills. The companies have also said the link between consumer ads and increased drug spending cited by critics is based on circumstantial evidence.

But a study released last week by the Kaiser Family Foundation, a nonprofit health charity based in Menlo Park, concludes that the consumer ads do help to sell more drugs and that the educational benefits of such advertising is mixed. Last summer, researchers studied 1,872 people, who were placed in one of three groups. The groups were shown ads for one of three brand-name drugs used to treat the following conditions: high cholesterol, asthma and acid reflux.

After viewing the ads, 50% of those who were affected by the condition--either personally or through a close acquaintance--said they would talk to their doctor about the medicine. The study participants said they recalled only about half of the drug’s possible side effects after viewing the ads. (In approving direct-to-consumer drug advertising in 1997, the Food and Drug Administration required the ads to have prominent statements about the risks and side effects of drugs.) The study suggested that consumers’ retention of such drug-risk information is somewhat spotty.

Linda Marsa