Archive for Friday, June 25, 1999

DRUGS REQUIRE MORE MONITORING

June 25, 1999

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Those who call for free or subsidized prescription drugs under Medicare may well be pushing for a "reform" that would do more harm than good.

According to the National Association of Chain Drug Stores, the number of prescriptions dispensed in retail pharmacies has jumped from 2.03 billion in 1992 to 2.78 billion last year. And with this rapid increase, there has been a commensurate rise in the number of adverse reactions from those who misuse their medications: As many as 10 percent of all hospital admissions in America can be attributed to adverse drug reactions (ADRs) caused by mismedication.

Our associate Dale Van Atta has interviewed dozens of doctors and experts to detail the problem. Nevertheless, we found that nobody actually knows the full dimension of the problem, because ADRs are only reported through a voluntary program called MEDWatch, administered by the Food and Drug Administration. But when the state of Rhode Island looked into the program, it found that only about 1 percent of all ADRs are being reported to the FDA.

The Journal of the American Medical Assn. published a study last year that estimated 2.2 million hospital patients are injured each year by adverse prescription drug reactions, and about 106,000 patients die as a result.

Another reputable medical study found that twice as many people in America die from prescription drugs than from illegal narcotics like cocaine and heroin.

Many of those who die are elderly. Older Americans take a disproportionate amount of prescription drugs, and they are the most susceptible to errors that cause crippling and fatal drug reactions. These are the very people to whom the Democratic party and seniors groups want to make more prescription drugs available by having taxpayers subsidize the cost.

The problem begins with the doctors, who are often subtly or overtly pressured by their elderly patients to write prescriptions -- whether or not they're actually needed. Older Americans were conditioned early in life by the discovery of penicillin and the polio vaccine to view pharmaceuticals as a panacea.

If they don't leave the doctor's office happily clutching a prescription, they may visit another doctor who will give them a pill for what ails them, real or imagined. According to the National Center for Health Statistics, the chances that a visit to a doctor will result in a prescription for medication is three in five.

A second factor behind adverse drug reactions is that doctors often fail to ask for -- or patients never volunteer -- a list of what other medications they are taking.

Mixing drugs is dangerous, and sometimes lethal. Elderly people in particular often take a baffling array of prescriptions whose side effects inter-mix. The late Rep. Claude Pepper, D-Fla., used to shake his head in disbelief as senior citizens would come to committee hearings with large plastic bags filled with pills of every variety.

William Simonson, professor at Oregon State University's College of Pharmacy, recalled the case of one older woman admitted to a hospital for "drugged behavior." Drugged indeed. She was taking 75 different prescription and nonprescription medications. "This woman was going to lots and lots of pharmacies. She was convinced that she needed all these pills to remain healthy, and she feared having them taken from her."

Other ADR factors particularly pronounced among the elderly are the tendencies to stockpile and swap drugs. This can be quite dangerous, especially if the drugs are out-of-date.

If a prescription has expired, the dosage may have been so weakened over time that the patient gets worse while falsely believing he should be getting better. Trading drugs can be even worse. It's not unusual for a husband to use a wife's left-over arthritis drug because it worked for her -- without ever consulting a doctor. Nor is it unusual for seniors to swap drugs with friends and neighbors without regard to potential harm.

One survey by the AARP found that 10 percent of elderly respondents loaned their prescribed medicines to others, and 7 percent confessed to "sometimes" borrowing medicine from friends.

"The children of the Depression hoard and loan," explains a Texas expert, Dr. Ron J. Anderson. "When I was a pharmacist, I remember people coming in asking me for 'the blue pill that worked so great for Mildred.' And the day after, I was searching the files to find that blue pill, and she'd say, 'No, no, I think it was red. It definitely was red. It was much better -- it was a red pill. Maybe it wasn't Mildred. It might have been Margaret.'"

Before making prescription drugs more easily and cheaply available to older Americans under Medicare, we need to come up with a better system of monitoring their use -- and avoiding mismedication and harmful drug reactions.

-- Jack Anderson and Jan Moller are columnists for United Feature Syndicate.

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