…Julia Hallisy learned about patient safety the hard way. Hallisy’s daughter, Kate, was diagnosed with an aggressive eye cancer when she was five months old. Over the next decade, she went through radiation, chemo, reconstructive surgery, an operation to remove her right eye, a hospital-acquired infection that led to toxic-shock syndrome and an above-the-knee amputation…
At the time I wrote: “Remarkably, The Empowered Patient is not an angry book. It is not maudlin. To her great credit, Hallisy manages to keep her tone matter-of-fact as she tells her reader what every patient and every patient’s advocate needs to know about how to stay safe in a hospital.”
Recently, Hallisy emailed to tell me know that the book has now become a non-profit foundation: The Empowered Patient Coalition.
Go to their website and you will find fact sheets, checklists, and publications including, A Hospital Guide for Patients and Families that you can download at no charge. I found the Hospital Guide eye-opening. I have read and written a fair amount about patient safety in hospitals, but it told me many things that I did not know…
[Great outline of doctor/nursing hierarchy]
[Questions Patients and Advocates Should Ask]
[What To Look For In Your Medical Record]
- Oops! US Doctors Screw Up Surprisingly Often: Study (livescience.com)
- Patients as customers: surfing for hospital emergency departments with shorter wait times (blogs.vancouversun.com)
- My experience as an empowered patient (worldofdtcmarketing.com)
- How to Make Your Hospital Stay Safer and Cheaper: A Checklist (pbs.org)
- Hospitals Are Killing Us (lewrockwell.com)
From the 19 December 2011 Beth Medical Newsletter
Study gauges baseline interest in three-site OpenNotes trial
BIDMC Contact: Jerry Berger
BOSTON – Patients are overwhelmingly interested in exploring the notes doctors write about them after an office visit, but doctors worry about the impact of such transparency on their patients and on their own workflow, a Beth Israel Deaconess Medical Center (BIDMC) study suggests….
While many of the more than 100 primary care doctors who volunteered to participate in this experiment predicted possible health benefits from allowing patients to read their notes, the majority of those who declined participation were doubtful about positive impacts. And among the 173 doctors completing surveys, the majority expressed concerns about confusing or worrying patients with the content. Doctors also anticipated that they would write their notes less candidly and that responding to patient questions might be exceedingly time-consuming.
In contrast to the doctors surveyed, the nearly 38,000 patients who completed the baseline survey were almost uniformly optimistic about OpenNotes, and few anticipated being confused or worried
“The enthusiasm of patients exceeded our expectations,” wrote Walker. “Most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics.”
More than 90 percent favored making the notes available. Well over half anticipated improved adherence to their medications, 90 percent expected to feel more in control of their care, and four out of five predicted they would take better care of themselves….
- Doctors are cautious, patients enthusiastic about sharing medical notes (eurekalert.org)
- Patients eager to see doctor’s notes; physicians, not so much (seattletimes.nwsource.com)
- Patients Want to See What Doctors Write about Them, Says Survey (onehealthyblog.wordpress.com)
- Patients, Docs Differ on Online Notes (abcnews.go.com)
- Patients Want Electronic Link To Doctor’s Notes (informationweek.com)
- How much guidance do patients want with their medical decisions? (jflahiff.wordpress.com)
A 1 1/2 minute cartoon where a nurse slowly convinces a doctor on why the Internet is useful in patient education.
by MAGGIE KOZEL, MD at KevinMD.com (November 27, 2011)
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics. Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance. No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP. The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.
The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits. The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….
Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room. From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying. So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.
- Maggie Kozel, M.D.: Modern Pediatrics Needs Health Care to Evolve (huffingtonpost.com)
- Why can’t the United States have a smarter health care system? (kevinmd.com)
- The culture of medicine needs to change (jflahiff.wordpress.com)
- Four Major Flaws in Our Healthcare System (triplepundit.com)
- CareSource Teams Up with the Ohio Chapter, American Academy of Pediatrics to Support Asthma Pilot Project (prweb.com)
The US Agency for Healthcare Research and Quality is working to empower us through an ad campaign and online materials.
The Questions are the Answers campaign also features these Web pages
- Reducing Medical Mistakes with questions to ask your health care provider, how to prevent medical errors, and more
- Talking with Your Clinician with tips on how to give and get information, get quality care and more
- Planning for Surgery with questions to ask and tips
- Getting a Prescription with tips on keeping track of meds, how to take medicine safely, and more
- Links to Additional Patient Safety Resources
- Your Health Priorities Tool (AHRQ) (jflahiff.wordpress.com)
- I’m happy that patients use the internet (ScienceRoll)
- IOM Report: Government Should Consider Public Health Implications Of All Major Legislation (jflahiff.wordpress.com)
- Question Authority (centerforhealthmediapolicy.com)
Antibiotic overuse and resistance have emerged as major threats during the past two decades. Following an outbreak of Clostridium difficile infections, which often result from antibiotic use, health care professionals in Quebec, Canada targeted physicians and pharmacists with an education campaign that reduced outpatient antibiotic use, according to a study published in Clinical Infectious Diseases and now available online.
The Quebec Minister of Health and the Quebec Medication Council collaborated with designated physicians and pharmacists to develop guidelines to improve prescribing practices. First issued in January 2005, the guidelines emphasized proper antibiotic use, including not prescribing antibiotics when viral infections were suspected and selecting the shortest possible duration of treatment. Approximately 30,000 printed copies of the original recommendations were distributed to all physicians and pharmacists in Quebec. An additional 193,500 copies were downloaded from the Medication Council’s website.
(The current versions of the guidelines are available online: http://www.cdm.gouv.qc.ca/site/aid=166.phtml.)
During the year after the guidelines were initially distributed, the number of outpatient antibiotic prescriptions in Quebec decreased 4.2 percent. In other Canadian provinces, the number of these prescriptions increased 6.5 percent during the same period.
According to study author Karl Weiss, MD, of the University of Montreal, “It is possible to decrease antibiotic consumption when physicians, pharmacists, state governments, etc., are working together for a common goal. This is the key to success: having everybody involved and speaking with a common voice.”
Dr. Weiss added, “Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available. The web is an increasingly important tool to reach our audience and should now be used as such in the future. With handheld electronic devices available for all health care professionals, these downloadable guidelines can be accessed and used at any time and any circumstance.”
- Superbug gonorrhoea found in Japan (newscientist.com)
- Drug-resistant STD prompts global warning (independent.co.uk)
- (Reuters) – Scientists have found a “superbug” strain of gonorrhea in Japan that is resistant to all recommended antibiotics and say it could transform a once easily treatable infection into a global public health threat. (theboldcorsicanflame.wordpress.com)
e-patient Dave de Bronkart was successfully treated for kidney cancer at a very late stage. He credits his recovery to using the Internet to find trusted medical information as well as to get advice from patients via support groups.
His video Let Patients Help outlines how and why patients should empower themselves.
Some video highlights
- Patients are presently the most underutilized part of the health team
- The e-patient movement is at least partly based on hippie ideals of self-reliance and self-care (think Whole Earth Catalog)
- e-patients are empowered, engaged, equipped and enabled through finding information to use in discussions regarding treatment options with their health care providers
- Support groups often are useful in providing information not available at other sites (as which doctors specialize in certain treatments)
- Patients not only need quality information, but also access to their raw medical data
How to evaluate medical and health information
- Evaluating Internet health information (Penn State)
- Evaluating Medical Research Findings and Clinical Trials (Family Caregiver Alliance)
- A Consumer’s Guide to Taking Charge of Health Information (Harvard Center for Risk Alliance)
- Evaluating Health Information on the Internet (National Cancer Institute)
- Quackwatch: Your Guide to Quackery, Health Fraud, and Intelligent Decisions (Stephen Barrett, M.D.)
Great starting places for quality health and medical information
- MedlinePlus (US National Library of Medicine/National Institutes of Health)
Links to information on over 700 diseases/conditions, drugs & supplements, videos & tools (as health calculators, anatomy videos, directories (as Find an Eye Doctor), and links to organizations
- UpToDate For Patients
Click on the Patient Information tab to find free information written for patients. These topics help one to learn more about a medical condition, better understand management and treatment options, and have a better dialogue with health care providers. This free information is adapted from the subscription based service UpToDate (which is for and by physicians and researchers).
- US Centers for Disease Control and Prevention (CDC)
Includes Health Topics A to Z, and sections as Diseases and Conditions as Healthy Living
- eMedicine Consumer Health
Comprehensive continuously updated health and medical information written by physicians. Information on specific diseases/conditions includes overviews, causes, diagnosis, treatments, outlook, and additional links. Slideshows, images, pictures,medications, and quizzes.
emedicine.com is geared towards health professionals. However it is free to all who register.
- But Wait, There’s More!
- Online consumer health guides, as Consumer Health (University of Toledo), Consumer Health (University of Florida), Consumer Health Guide (University of California)
Libguides are written by librarians on every subject imaginable. They are free to all.
- Never underestimate the finding power of a librarian.
Many academic and medical institutions offer at least some reference services to the general public. Be sure to ask for a reference librarian. He or she not only has a master’s degree in Library Science, but often additional related education in health related areas.
Online Health Communities/Support Groups
- Self-Help Group SourceBook Online
A starting point for finding every type of national, international, model and online self-help support group that is available starting point for finding every type of national, international, model and online self-help support group that is available. (MentalHelp.net)
Search with a phrase as “support groups” cancer or select a Health topic and select an organization.
- Medpedia communities
This site allows people with common health interests to share information and communicate. Anyone may create a community of interest and anyone may join.Medpedia is an open platform connecting people and information to advance medicine. Users include health care professionals, health care organizations, expert lay persons, students, and scientists.
- MedHelp International
This online health community which not only provides health information but helps patients actively manage their health through online personal health records andMedhelp trackers (iphone friendly options).
The People option allows one to search by a disease or condition to find related information (including symptoms, treatments, resources). One can also view postings and blogs by other members and interact with them.
Medical experts helps users by answering questions in Ask-an-Expert forums, participating in conversations with members in free live health chats, and sharing their knowledge and the latest news in blogs
- Mayo Clinic Online Community is ” free and is open to anyone, whether you have been a patient at Mayo Clinic or not. It includes content from various Mayo Clinic blogs,health and medical videos from Mayo’s YouTube channel and links to news articlesabout Mayo Clinic research and treatment advances. It also features a discussion forum where members can connect with others who have similar interests or concerns.”
A few related postings from my blog
- [How to] Explore Your Treatment Options
- Free Online Anatomy Sites
- How to obtain free/low cost articles from medical journals
- Plain language summaries Web sites explain medical studies for all
shift toward more conservative medication-prescribing practices would serve patients better, according to a review article published Online First today by Archives of Internal Medicine, one of the JAMA/Archives journals***. The article is part of the journal’s Less Is More series.
As background, the article notes that the majority of patients under age 65 years receive at least one prescription drug annually. However, according to the authors, not every patient visit needs to result in a prescription. They point to “the recent spate of revelations of undisclosed and unexpected adverse effects of drugs in multiple therapeutic categories” as just one reason to take a more measured approach to medication usage…
…Among the steps they recommend for conservative prescribing:
- Think beyond drugs. Would other interventions help? Would a medication simply mask symptoms without treating the problem? Can a condition be prevented instead of treated? Would waiting to see if the symptoms self-resolve be wise?
- Practice more strategic prescribing. Do you have a solid understanding of medication choices? Is there a valid reason to switch to a new drug? Is it the right drug for your patient? Can you avoid using multiple medications?
- Maintain heightened vigilance regarding adverse effects. Do you check with patients about potential drug reactions? Do you teach them the warning signs? Are the drugs you’re choosing prone to withdrawal symptoms or relapse?
- Approach new drugs and new indications cautiously and skeptically. Where do you get your information about new treatments? Can you wait until a new drug has had a longer track record? Does the drug actually help resolve the core problem? Is it actually indicated for this problem? Does it deliver what it promises? Do studies tell the whole story on a drug?
- Work with patients for a more deliberative shared agenda. Can you persuade patients not to demand drugs they have seen or heard advertised? Is a patient’s noncompliance with therapy the source of the problem? Has the patient already tried this drug without success? Can you encourage healthy skepticism in your patients?
- Consider longer-term, broader effects. Would a different therapy be less likely to cause future harm? Can you find a way to make the prescribing system better?
…Listening, saying sorry, and validating the complaint by repeating the complaint word for word – or least paraphrasing – can solve the majority of the problems and diminish the need for fights. Sometimes people just want to be heard…hear their complaints and gripes about life validated. Doesn’t mean necessarily you’re wrong and they’re right….they just need to blow off steam. Also, for some people after hearing their complaint repeated back it makes them realize they’re making a mountain out of a mole hill….they’re being unfair, unreasonable, and even silly. ….
..Source: Sorry Works! (“advocacy organization for disclosure, apology (when appropriate), and upfront compensation (when necessary) after adverse medical events.”)
- 10 steps to a successful complaint (telegraph.co.uk)
NEW YORK (Reuters Health) – Official reports of negative reactions to prescription drugs have increased dramatically over the last decade, according to a new study.
In a U.S. Food and Drug Administration (FDA) database launched in 1969, researchers found that over half the reports of “adverse events” suspected to be caused by a particular drug or device date from just the past 10 years.
The FDA currently receives about half-a-million such reports of health problems, and even deaths, associated with medical products each year. In 2000, they came in at a rate of nearly five for every 10,000 office visits in which at least one prescription was written. By 2005, that rate had risen to nearly seven per 10,000 visits, according to the new analysis published in the Archives of Internal Medicine.
Between 2000 and 2010, the number of reports coming in grew steadily by more than 11 percent every year. By 2010, they added up to 2.2 million reports — 55 percent of the entire database total.
Study author Dr. Sheila Weiss-Smith of the University of Maryland in Baltimore cautioned that the number of reports does not equal the true number of negative reactions to drugs.
Manufacturers are required to report to the FDA any health problem they suspect stems from one of their products, but for doctors, patients, lawyers, and anyone else who reports these reactions, it’s entirely voluntary, she told Reuters Health.
It’s hard to estimate how many negative reactions to drugs actually occur, Weiss-Smith noted. Some experts suggest official reports represent one-tenth of the number of actual negative reactions, but she said she doesn’t trust that figure. “We just don’t know. We don’t know what percentage of events actually gets reported.”…
…More people are taking drugs, and for longer times, which increases the potential for bad reactions, and negative interactions between drugs, she said….
…Negative reactions can occur from a variety of drugs, and patients need to take steps to protect themselves, Weiss-Smith urged. “Drugs are chemicals. And you’re putting something in your body. You need to know what it is.” [Editor Flahiff's emphasis]She recommended that everyone tell their doctors what they are taking, and try to go to one pharmacy, “so someone can keep track of all the different things,” preventing negative interactions.
If you keep adding drugs to your daily routine, talk to your doctor about whether you can cut back on others, so that you are only taking the minimum necessary amount, she said. Read all the material that comes with medicines, and tell someone immediately if you start to feel unwell. “If something doesn’t feel right, talk to your doctor, talk to your pharmacist.” [Flahiff's emphasis]
Are you looking for information about a drug? to use for consultations with your health care provider?
Please use reputable resources that strive to provide unbiased information.
Pharmacists are great sources of information. Practicing pharmacists are college graduates (many with Master’s degrees) that are state licensed. Many give free information at their place of business, they seldom ask if you are one of their customers!!
Also, don’t forget librarians as your personal, professional guides to information in print and online resources.
Contact your local public, academic, or medical library. Many medical and academic libraries, especially those state funded, give at least some assistance to the public. Call ahead. You may be pleasantly surprised!
And, as always, contact me( jmflahiff who virtually resides at yahoo.com)
Some examples of good drug information Web sites
Prescription and over-the-counter medication information contains answers to many general questions including topics as what a drug is used for, precautions, side effects, dietary instructions, and overdoses. From the American Society of Health System Pharmacists
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
Drugs and Supplements (sponsored by the Mayo Clinic)
Somewhat lengthy drug and over-the-counter medicationinformation with these sections: description, before using, proper use, precautions and side effects. From Micromedex, a trusted source of healthcare information for health professionals.
Herb and supplement information includes information on uses based on scientific evidence as well as safety and potential interactions with drugs, herbs, and supplements. From Natural Standard, an independent group of researchers and clinicians.
A good central source of drug information by the US government (the National Institutes of Health). It links you to information on over 12,000 drugs from trusted consumer drug information sources, the US Food and Drug Information, and LactMed (summary of effects on breastfeeding), It also gives any summaries from medical and toxicological articles (however, some whole articles may not be for free on the Internet).
- Online Medical Advice Can Be a Prescription for Fear (jflahiff.wordpress.com)
- Drug Information Product DailyMed Mobile Version Launched (jflahiff.wordpress.com)
- Fewer fill “dispense as written” prescriptions – study (reuters.com)
- What’s In OTC Painkillers? Most Americans Don’t Know
- Study shows pharmacies’ software systems miss potentially dangerous interactions (Eureka alert, May 2011)
ScienceDaily (Mar. 25, 2011) — Approximately five percent of prescriptions submitted by CVS Caremark Pharmacy Benefit Management (PBM) members in a 30-day period during 2009 included a “dispense as written” (DAW) designation. This practice — whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative — costs the health care system up to $7.7 billion annually, according to a new study by researchers at Harvard University, Brigham and Women’s Hospital and CVS Caremark. Moreover, these requests reduce the likelihood that patients actually fill new prescriptions for essential chronic conditions.
In a study published this week in the American Journal of Medicine,*** the researchers demonstrate that DAW designations for prescriptions have important implications for medication adherence. They found that when starting new essential therapy, chronically ill patients with DAW prescriptions were 50 to 60 percent less likely to actually fill the more expensive brand name prescriptions than generics. “Although dispense as written requests would seem to reflect a conscious decision by patients or their physicians to use a specific agent, the increased cost sharing that results for the patient may decrease the likelihood that patients actually fill their prescriptions,” the researchers said……
ScienceDaily (Mar. 7, 2011) — A review of 35 years of scientific medical studies confirms that the social and emotional context of the doctor-patient relationship have yet to be incorporated into the equation when it comes to health care….
“We are only at the water’s edge in terms of availability of patient-centered care studies because they aren’t being done. We need to encourage researchers to implement clinical trials that evaluate care that focuses on communication between physician and patient. Ultimately, we need processes that have been tested and proven,” said Richard M. Frankel, Ph.D., Regenstrief Institute investigator, professor of medicine at the IU School of Medicine, and a senior scientist in the Veterans Affairs Center of Excellence for Implementing Evidence-Based Practice at the Richard L. Roudebush VA Medical Center. He is the senior author of the JGIM paper.
Dr. Frankel uses an analogy from aviation where safety is given the highest priority. “When the air traffic controller gives an instruction to the pilot, the pilot’s response must be phrased to indicate understanding of the air traffic controller’s message. We don’t have that in medicine. The doctor speaks to the patient and generally does not solicit a response that clearly indicates the patient understood what the doctor wished to convey.”…
Health care spending: Study shows high imaging costs for defensive purposes
Costs and frequency of defensive medicine in Pennsylvania
Nearly 35 percent of all the imaging costs ordered for 2,068 orthopaedic patient encounters in Pennsylvania were ordered for defensive purposes, according to a new study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
For many years now, some physicians have ordered specific diagnostic procedures that are of little or no benefit to a patient, largely to protect themselves from a lawsuit. Until now, however, efforts to actually measure defensive medicine practices have been limited primarily to surveys sent to physicians. Such surveys would simply ask whether or not that individual actually practiced defensive medicine.
“This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time — prospectively done,” says John Flynn, MD.
Flynn, who is Associate Chief of Orthopaedic Surgery at Children’s Hospital of Philadelphia, says that many lawsuits hinge on the plaintiff’s lawyer’s claim that the doctor should have ordered extra diagnostic testing. “And such a claim may be the driving force of so much of the defensive test ordering.”
According to Flynn, 72 orthopaedic surgeons, who are members of the Pennsylvania Orthopaedic Society, voluntarily participated in this study, which included some 2,068 patient encounters throughout the state of Pennsylvania. Most patients in this study were adults. The study found that 19 percent of the imaging tests ordered were for defensive purposes. Defensive imaging was responsible for $113,369 of $325,309 (34.8 percent) of total imaging charges for this patient cohort, based on Medicare dollars. The overall cost of these tests was 35 percent of all imaging ordered because the most common test was an MRI, an imaging test which costs more than a regular X-ray.
One piece of this problem to remember, Flynn says, is that the legal environment that drives physicians to order additional tests has an effect on patients too, in a way that involves more than costs. “Patients are sometimes put through tests that maybe otherwise would not be ordered.”
The finding from this research that surprised Flynn the most was that surgeons were more likely to practice defensively if they had been in practice for more than 15 years.
“This was counterintuitive,” he says. “I thought that young doctors would come out of medical school immediately after training, be less confident because they weren’t experienced, and order more defensive tests. Then, as they become more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests.”
“In fact, the opposite was true. We found that — in Pennsylvania at least — a surgeon’s defensive nature gets worse over time. In this legal environment, orthopaedic surgeons order more imaging tests of a defensive nature, because over time they become more concerned that someone is going to second guess or sue them.”
Flynn says that medical liability awards typically are given because of the severity of a bad outcome, and not necessarily because of negligence. In fact, a May 2006 study published in the New England Journal of Medicine (Studdert DM) showed that 37 percent of claims did not involve medical errors, and in 3 percent of claims, no injury occurred at all.
Flynn pointed to various studies that show that defensive medicine, in general, is quite prevalent. One such study in the June 2005 Journal of the American Medical Association (Studdert DM) reported that almost 93 percent of 824 physicians in Pennsylvania responding to a survey practiced defensive medicine.
“Ideally, as a next step, we would hope to try to get a broader national picture using this prospective practice audit methodology, so we could get a better sense of the true costs of defensive imaging in orthopaedics,” says Flynn.
“Ultimately, if you had doctors from multiple specialties — from OB/Gyn to Neurosurgery to Emergency Medicine — do this type of practice audit, you could accurately quantify how much of our nation’s healthcare resources are wasted on defensive medicine.”
NEW YORK (Reuters Health) – More than a quarter of Americans taking antidepressants have never been diagnosed with any of the conditions the drugs are typically used to treat, according to new research.
That means millions could be exposed to side effects from the medicines without proven health benefits, researchers say.
“We cannot be sure that the risks and side effects of antidepressants are worth the benefit of taking them for people who do not meet criteria for major depression,” said Jina Pagura, a psychologist and currently a medical student at the University of Manitoba in Canada, who worked on the study.
“These individuals are likely approaching their physicians with concerns that may be related to depression, and could include symptoms like trouble sleeping, poor mood, difficulties in relationships, etc.,” she added in an e-mail to Reuters Health. “Although an antidepressant might help with these issues, the problems may also go away on their own with time, or might be more amenable to counseling or psychotherapy.”
The researchers tapped into data from the Collaborative Psychiatric Epidemiologic Surveys, which include a nationally representative sample of more than 20,000 U.S. adults interviewed between 2001 and 2003.
Roughly one in ten people told interviewers they had been taking antidepressants during the past year. Yet a quarter of those people had never been diagnosed with any of the conditions that doctors usually treat with the medication, such as major depression and anxiety disorder.
According to The National Institute of Mental Health, nearly 15 million American adults suffer from major depression, and 40 million more have anxiety disorders.
Although the survey didn’t include all mental illnesses that might have led doctors to prescribe an antidepressant — say, obsessive-compulsive disorder or to help quit smoking — other experts said the new findings are not exaggerated.
“Reviews of claims records, which are diagnoses actually given by health care professionals, suggest that only about 50% of patients who are prescribed antidepressants receive a psychiatric diagnosis,” said Dr. Mark Olfson, a psychiatrist at Columbia University in New York.
“These findings raise questions about the clinical appropriateness of antidepressant treatment selection for many primary care patients,” he added in an e-mail to Reuters Health.
With sales of $9.9 billion in 2009, up three percent since the previous year, antidepressants rank fourth among prescription drugs in the U.S., according to IMS Health, a company that analyzes the pharmaceutical industry.
Popular brand names include Pfizer’s Zoloft, Forest Laboratories’ Lexapro and Eli Lilly’s Prozac.
While studies have shown the drugs may help some people with depression, they come with a price tag — and not only the $100 or more that a month’s supply can cost. Some users experience sexual problems or gain weight, for instance.
“Nearly all medication has side effects, so there are undoubtedly a large number of Americans who are taking antidepressants that may not be effective at treating their conditions, yet they suffer from the side effects,” said Jeffrey S. Harman, an expert in health services at the University of Florida in Gainesville, who was not involved in the new study.
“Not to mention inappropriate use of our health care dollars that comes along with inappropriate prescribing,” he added in an e-mail.
Still, Harman said the findings, published in the Journal of Clinical Psychiatry***, didn’t necessarily mean doctors are prescribing more antidepressants than they should.
“As far as overprescribing, I don’t think you can say that it is occurring as a blanket statement,” he explained. “There are undoubtedly many people being prescribed antidepressants that may not be effective for them, but there are also millions of Americans suffering from depression who are not being prescribed antidepressants or are being prescribed them at a suboptimal dose.”
Pfizer did not comment directly on the new findings, but told Reuters Health it was dedicated to ensuring “that patients and their doctors have the most up to date medical information on which to base their treatment decisions.”
SOURCE: http://bit.ly/eXPVSL*** Journal of Clinical Psychiatry, online January 25, 2011.
*** For suggestions on how to get this article for free or at low cost, please click here