How Two Rights Can Make a Wrong
By HOWARD MARKEL, M.D., NYTimes.com
February 25, 2007
SOME 3.6 billion prescriptions were purchased in the United States in 2005, according to the Kaiser Family Foundation, an increase of more than 70 percent compared with the number in 1994, and a trend that has continued as the population ages and new drugs enter the market.
But as Americans take an ever-increasing array of prescription and over-the-counter medications and herbal supplements, the nation’s patients and doctors find themselves facing a growing problem — too many patients are unwittingly taking dangerous combinations of drugs.
Since the days of Hippocrates, physicians have recognized that some medications do not mix well with others. Certain drug combinations can be deadly, and many commonly prescribed or over-the-counter drugs have the potential to increase the dangerous risks of other medications when taken together. Physicians call these scenarios “adverse drug events,” and they run the gamut from upset stomach to coma or even death.
In recent years, what had seemed like the occasional mishap has become a full-scale epidemic.
There’s no question that these drugs offer patients the possibility of modern-day miracles. But sometimes patients mislead doctors about the medications they take. Or they might assume the doctor knows. Or patients taking an over-the-counter medication simply forget. Doctors can also fail to take a patient’s drug history or inquire whether other doctors have also prescribed medications for their patients.
When that happens, the potential for problems is enormous.
In 2004, 82 percent of the United States population reported using at least one prescription drug, over-the-counter medication, or dietary supplement in the previous week, and 30 percent reported using five or more of these during the same period, according to a study by the Sloan Epidemiology Center at Boston University. Among senior citizens, 75 percent of all Americans over the age of 65 took roughly four prescription drugs on a daily basis in 2005; the average 75-year-old in the United States swallowed eight different prescription medications each day. That same year, approximately 1.6 million American teenagers and children (almost 300,000 of whom were under 10) were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions for The New York Times.
The resulting increase in adverse drug reactions has been particularly striking among patients being treated for common health problems ranging from hypertension, heart disease and diabetes to cancer and gastroesophageal reflux, as well as a host of other maladies.
Last October, The Journal of the American Medical Association reported that adverse drug events are a major cause of serious illness in the country, especially among the elderly.
Dr. Daniel Budnitz, a physician at the Centers for Disease Control and Prevention and the lead author of the study, discovered that individuals 65 years or older were more than twice as likely to be treated in an emergency room for adverse drug events and nearly seven times as likely to require hospitalization as individuals younger than 65. Almost all of those expensive hospitalizations were due to unintentional overdoses and, of those, two-thirds were due to toxic effects from a small set of drugs well known to require regular monitoring to prevent such mishaps.
The journal study revealed that the majority of those who found themselves in hospital beds for an adverse drug event were merely following their doctor’s orders — or the orders of several doctors. According to a recent study on physician prescription practices by the Columbia University Center for Addiction and Substance Abuse, fewer than 40 percent of all physicians in the United States take the time to contact a patient’s other physicians to find out what additional medications their patient may be taking.
In August 2006, the Institute of Medicine of the National Academies released a major study on medication errors in American hospitals that found that adverse drug events harm more than 1.5 million people and kill several thousand a year, costing at least $3.5 billion annually. Dr. J. Lyle Bootman, dean of the University of Arizona College of Pharmacy and the report’s lead author, said, “the incidence of medication errors was surprising even to us.”
The leading culprits identified in the institute’s report include a generalized failure of hospitals to computerize the dispensing and delivery of these powerful medications. In an era dominated by the computer, only 6 percent of American hospitals use drug computer entry systems that ensure that patients get the correct medication at the correct dose.
In the ambulatory or outpatient setting, experts agree, much can be done not only by providing patients with detailed information about the medications they take but also by imposing strict requirements that patients bring a complete list of all the medications they take to every health care professional they consult. Perhaps even more important, they say, is the development of a secure, confidential, computerized system of electronic prescriptions that shares a patient’s medication history among everyone prescribing and dispensing a drug.
By HOWARD MARKEL, M.D., NYTimes.com
February 25, 2007
SOME 3.6 billion prescriptions were purchased in the United States in 2005, according to the Kaiser Family Foundation, an increase of more than 70 percent compared with the number in 1994, and a trend that has continued as the population ages and new drugs enter the market.
But as Americans take an ever-increasing array of prescription and over-the-counter medications and herbal supplements, the nation’s patients and doctors find themselves facing a growing problem — too many patients are unwittingly taking dangerous combinations of drugs.
Since the days of Hippocrates, physicians have recognized that some medications do not mix well with others. Certain drug combinations can be deadly, and many commonly prescribed or over-the-counter drugs have the potential to increase the dangerous risks of other medications when taken together. Physicians call these scenarios “adverse drug events,” and they run the gamut from upset stomach to coma or even death.
In recent years, what had seemed like the occasional mishap has become a full-scale epidemic.
There’s no question that these drugs offer patients the possibility of modern-day miracles. But sometimes patients mislead doctors about the medications they take. Or they might assume the doctor knows. Or patients taking an over-the-counter medication simply forget. Doctors can also fail to take a patient’s drug history or inquire whether other doctors have also prescribed medications for their patients.
When that happens, the potential for problems is enormous.
In 2004, 82 percent of the United States population reported using at least one prescription drug, over-the-counter medication, or dietary supplement in the previous week, and 30 percent reported using five or more of these during the same period, according to a study by the Sloan Epidemiology Center at Boston University. Among senior citizens, 75 percent of all Americans over the age of 65 took roughly four prescription drugs on a daily basis in 2005; the average 75-year-old in the United States swallowed eight different prescription medications each day. That same year, approximately 1.6 million American teenagers and children (almost 300,000 of whom were under 10) were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions for The New York Times.
The resulting increase in adverse drug reactions has been particularly striking among patients being treated for common health problems ranging from hypertension, heart disease and diabetes to cancer and gastroesophageal reflux, as well as a host of other maladies.
Last October, The Journal of the American Medical Association reported that adverse drug events are a major cause of serious illness in the country, especially among the elderly.
Dr. Daniel Budnitz, a physician at the Centers for Disease Control and Prevention and the lead author of the study, discovered that individuals 65 years or older were more than twice as likely to be treated in an emergency room for adverse drug events and nearly seven times as likely to require hospitalization as individuals younger than 65. Almost all of those expensive hospitalizations were due to unintentional overdoses and, of those, two-thirds were due to toxic effects from a small set of drugs well known to require regular monitoring to prevent such mishaps.
The journal study revealed that the majority of those who found themselves in hospital beds for an adverse drug event were merely following their doctor’s orders — or the orders of several doctors. According to a recent study on physician prescription practices by the Columbia University Center for Addiction and Substance Abuse, fewer than 40 percent of all physicians in the United States take the time to contact a patient’s other physicians to find out what additional medications their patient may be taking.
In August 2006, the Institute of Medicine of the National Academies released a major study on medication errors in American hospitals that found that adverse drug events harm more than 1.5 million people and kill several thousand a year, costing at least $3.5 billion annually. Dr. J. Lyle Bootman, dean of the University of Arizona College of Pharmacy and the report’s lead author, said, “the incidence of medication errors was surprising even to us.”
The leading culprits identified in the institute’s report include a generalized failure of hospitals to computerize the dispensing and delivery of these powerful medications. In an era dominated by the computer, only 6 percent of American hospitals use drug computer entry systems that ensure that patients get the correct medication at the correct dose.
In the ambulatory or outpatient setting, experts agree, much can be done not only by providing patients with detailed information about the medications they take but also by imposing strict requirements that patients bring a complete list of all the medications they take to every health care professional they consult. Perhaps even more important, they say, is the development of a secure, confidential, computerized system of electronic prescriptions that shares a patient’s medication history among everyone prescribing and dispensing a drug.
