Healthy Skepticism Library item: 15139

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Graham J.
Doctor, do I really need that drug?
The Chicago Tribune 2009 Feb 24
http://newsblogs.chicagotribune.com/triage/2009/02/doctor-do-i-really-need-that-drug.html

Full text:

It’s time for doctors to become more conservative in prescribing drugs to patients, according to a commentary by two physicians in the current issue of the Journal of the American Medical Assn.

Both have strong Chicago ties. Dr. Gordon Schiff, the lead author, practiced for several decades at Stroger Hospital and now works at Harvard Medical School. Dr. William Galanter heads the pharmacy and therapeutics committee at the University of Illinois at Chicago Medical Center.

Over the past several years, the two physicians have led a program to teach pharmacy students and physicians in Chicago about the principles of what they call “conservative prescribing.”

Among their goals: to encourage doctors to use drugs with a proven track record and to convince colleagues that writing a prescription for every ailment often isn’t necessary.

The approach is important given the drug industry’s “ubiquitous promotional messages encouraging (providers) to reach for newer and often more expensive medications,” the physicians write in their JAMA commentary.

What’s needed, they say, is an emphasis on alternative ways of helping patients including physical therapy, dietary changes, exercise, counseling and stress reduction techniques. Too many doctors recommend medications because it’s a quick, easy way of appearing to do something, they note.

I caught up with Schiff today at his office in Boston and asked him how the principles outlined in his JAMA commentary apply to consumers.

“People need to change the way they think about taking medications,” he said. “Just because a drug is new doesn’t mean it’s better than medications that have been around for a while. It’s a good idea to be skeptical about the drug ads you see on TV. And it’s important to talk with your doctor about the drugs he’s recommending.”

What questions should people ask, I inquired.

It wasn’t an issue Schiff had considered in the JAMA commentary. But after giving it some thought, several queries came readily to mind:

• Is there a non-drug alternative to this drug? What’s the evidence for and against that alternative versus the drug? Why are you recommending the medication?

• What are the expected side effects? Could there be there be interactions with other medications I’m taking?

• Is this a new drug or an older drug? If it’s a new drug, how much experience has there been with this medication? Are its side effects well known? Is it really better than the older drugs in its class?

• Am I taking any drugs I could do without? If I needed the drug in the past, do I still need it? If I’m taking multiple drugs, can we possibly consolidate them so I can take fewer?

• If you’re planning on prescribing several new drugs, can I start off with just one and see how it works and how I tolerate it before taking the others? Will it hurt me to hold off on taking the other medications?

I suspect there are several other questions that could be added to this list. Two come to my mind: “Doctor, is this drug approved by the Food and Drug Administration for the use for which you’re prescribing it?” and “Doctor, have there been any safety issues associated with this drug?”

What questions would you add to this list?