Tuesday, April 22, 2014

The Cost of the Misuse of Prescription Drugs

The ever increasing cost of pharmaceuticals is a major driver of the American healthcare crisis. At GBMC, the cost of pharmaceuticals for our employees has gone up by 13% this year. We see drug expenses rising for many reasons. We are all willing to pay more for drugs that truly generate better health. But what about paying significant amounts of money for drugs that really don’t, or paying for drugs when they actually cause harm?

I am a pediatrician and a fellow of the American Academy of Pediatrics. Last week, I received an alert from the Academy that got my attention. The alert said that the majority of pediatric Clostridium difficile infections, which are bacterial infections that cause severe diarrhea and are potentially life-threatening, occur among children in the general community who recently took antibiotics prescribed in doctors’ offices for other conditions. This came from a new study by the Centers for Disease Control and Prevention (CDC).  The study showed that 71 percent of the cases of C. difficile infection identified among children aged 1 through 17 years were community-associated—that is, not associated with an overnight stay in a healthcare facility. By contrast, two-thirds of C. difficile infections in adults are associated with hospital stays. The CDC has data to show that many patients get prescriptions for antibiotics when the evidence shows that they are not necessary.

The FY 2015 Federal Budget requests funding for CDC for an initiative to reduce outpatient prescribing of antibiotics by up to 20 percent and healthcare-associated C. difficile infections by 50 percent in five years. A 50 percent reduction in healthcare-associated C. difficile infections could save 20,000 lives, prevent 150,000 hospitalizations, and cut more than $2 billion in healthcare costs.

After reading this, I was reflecting on people rushing to Urgent Care Centers and their doctor’s office to get antibiotics, frequently for viral illnesses where the antibiotics don’t actually help. I am curious about what would happen to business at Urgent Care Centers if the rate of antibiotic prescribing went down, as the CDC is trying to encourage. I also wonder if physicians in their offices would have more time to spend with their patients talking about what would actually improve their health if they were not writing so many prescriptions.

It is absolutely clear that antibiotics were a major breakthrough of the twentieth century and that antibiotics improve health and save many lives when they are used appropriately, but doctors, nurse practitioners, pharmacists and patients need to do a better job of making sure that the use of all drugs, but especially antibiotics, follows the evidence.


  1. I actually work as a physician extender at an urgent care center as well as the ER. We are currently trying to cut our antibiotic prescriptions, and remain busy. I rarely prescribe them for URI symptoms. Most patients take no very well if you explain to them the reason why not.

  2. Thanks, Anonymous. I commend you for your efforts in evidence-based medicine.

  3. I have a friend who is a pediatrician. She says things are getting better, but she still encounters parents who demand antibiotics or they will take their business elsewhere. I am also concerned with the recent rise in heroin use now that there's a push to limit prescribing narcotics. That's been in the national news and on NPR. I guess it's the "Law of Unintended Consequences" in action.

    1. Thank you anonymous. Yes, as we have clamped down on the misuse of prescription pain killers, those with an addiction have sadly turned to illicit drugs.

  4. I agree that there is huge opportunity to reduce the waste of inappropriate prescribing and misuse of pharmaceuticals.

    I commend you for speaking on this issue.

    In order for these efforts to be successful, there must be collaboration involved, true evaluation of the literature, and evidence-based decision-making. The old school way was "I want it" and it was given. This culture must change in order to have any meaningful impact on reduction of waste in the system.

  5. We receive a weekly update about drug shortages, some of them critical, at GBMC. It's a shame the pharmaceutical companies don't address true needs; instead, they do things like push Androgel for this new phenomenon of "Low T" and they suddenly have a huge new market.for their product. Of course, the majority of their customers do not have a "Low T" problem at all (per reports on NPR and in the WSJ).

  6. Thanks, Anonymous. Yes, this is another example of a non-evidence based use of a pharmaceutical.


Thank you for taking time to read "A Healthy Dialogue" and for commenting on the blog. Comments are an important part of the public dialogue and help facilitate conversation. All comments are reviewed before posting to ensure posts are not off-topic, do not violate patient confidentiality, and are civil. Differing opinions are welcome as long as the tone is respectful.