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Thursday, September 29, 2016

by Tracy Weber and Charles Ornstein, ProPublica.

This article was co-published in the Op-Ed pages of the Los Angeles Times.

Your doctor hands you a prescription for a blood pressure drug. But is it the right one for you?

You’re searching for a new primary care physician or a specialist. Is there a way you can know whether the doctor is more partial to expensive, brand-name drugs than his peers?

Or say you’ve got to find a nursing home for a loved one. Wouldn’t you want to know if the staff doctor regularly prescribes drugs known to be risky for seniors or overuses psychiatric drugs to sedate residents?

For most of us, evaluating a doctor’s prescribing habits is just about impossible. Even doctors themselves have little way of knowing whether their drug choices fall in line with those of their peers.

Once they graduate from medical school, physicians often have a tough time keeping up with the latest clinical trials and sorting through the hype on new drugs. Seldom are they monitored to see if they are prescribing appropriately — and there isn’t even universal agreement on what good prescribing is.

This dearth of knowledge and insight matters for both patients and doctors. Drugs are complicated. Most come with side effects and risk-benefit calculations. What may work for one person may be absolutely inappropriate, or even harmful, for someone else.

Antipsychotics, for example, are invaluable in treating severe psychiatric conditions. But they are too often used to sedate older patients suffering from dementia — despite a “black-box” warning accompanying the drugs that they increase the risk of death in such patients.

The American Geriatrics Society has labeled dozens of other drugs risky for elderly patients, too, because they increase the risk of dizziness, fainting and falling, among other things. In most cases, safer alternatives exist. Yet the more dangerous drugs continue to be prescribed to millions of older patients.

And, as has been well documented by the Los Angeles Times and others, powerful painkillers are often misused and overprescribed –with sometimes deadly consequences.

As reporters who have long investigated health care and exposed frightening variations in quality, we wondered why so much secrecy shrouds the prescribing habits of doctors.

The information certainly isn’t secret to drug companies. They spend millions of dollars buying prescription records from companies that purchase them from pharmacies. The drugmakers then use the data to target their pitches and measure success.

But when we tried to purchase the records from the companies that supply them to drug manufacturers, we were told we couldn’t have them — at any price.

We next turned to Medicare, a public program that provides drug coverage to 32 million seniors and the disabled and accounts for one out of every four prescriptions written annually.

We filed a Freedom of Information Act request for prescribing data. After months of negotiation with officials, we were given a list of the drugs prescribed by every health professional to enrollees in Medicare’s prescription drug program, known as Part D.

What we found was disturbing. Although we didn’t have access to patient names or medical records, it was clear that hundreds of physicians across the country were prescribing large numbers of dangerous, inappropriate or unnecessary drugs. And Medicare had done little, if anything, about it.

  • Allan Richardson

    My gastro-enterologist has me on ursodiol, which my pre-Medicare coverage through my wife’s employer covered; I was paying $25 or less for 90 days through mail order. My Medicare supplement, which is very good in other ways, does not have it in their formulary, so my next 90 day order through THEIR pharmacy will cost $105. Their explanation is that their experts do not believe it is safe for people over 65. I will definitely discuss this with my doctor before my current supply runs out. But if MY doctor is right and THEIR doctors are wrong, it will still cost more and I will still have to pay more.

    • sigrid28

      Maybe you will not have to pay more. We had the rude awakening about drug costs when we lost our health insurance five years ago. By all means, research this question with your doctor as well as your pharmacy.

      However, you may be able to get this drug for less by buying it through the pharmaceutical company itself or through a medication supplier. One medication I take could costs $90 a month as generic, but through our supplier (there is a means test to qualify) costs $45 for three months. Start with Needymeds.com and then also look at RXoutreach.com. Insist on finding out.

  • howa4x

    The stark reality is that doctors are not here to heal you but to push drugs that don’t cure you. They and big Pharma have gotten together to prescribe drugs that only maintain the condition you have, sometimes making it worse, and all have damaging side effects. They have a racket where you have to constantly go back to your doctor to monitor the drugs effects on, not only the disease but other body organs like your liver. The side effects can be just as bad as the disease for example , my friend had high blood pressure and the drug he was on gave him diabetes. The FDA has become a rubber stamp for the drug industry and sadly to say it is the Lawyers that police the system. This is why republicans representing the drug industry are always calling for tort reform but not increased regulatory oversight. The lawyers also police the doctors since ethics boards are non existent, and state medical boards rarely take action. The entire system is about profit and drugs with the worst side effects and least efficacy are the most profitable. Sadly the drugs used in cancer treatment are the most deadly. Chemo therapy has limited utility and will only work on certain cancers, and the side effects are the most damaging. New Gene therapy is still on the back burner since most oncologists know little about it. Chemo drugs are by far the most profitable and that is why they are still prescribed for cancer that it has limited effects on. For Lung and pancreatic cancer your life expectancy is still less than a year and your quality of life will be closer to a near death experience. My friend died of state 4 lung cancer and I saw the horrible life he had taking chemo. One drug he had to take to counter Chemo sickness, cost over $100.per pill. His oncologist in NYC charged him over $15,000 for 4, 20 minute visits and 4 chemo sessions. The entire health care/illness intervention system is there to maximize profit for its members and every man, woman and child is seen as a future profit center. In a counter intuitive way this is a system that depends financially on you being ill, not well, and the sicker you are the more profit they make.

  • Pamby50

    I have lucked into some good doctors. I have a neuromuscular disease. All that I read gave me around 10 yrs. Still kicking 19 1/2 yrs later. All my doctors talk to each other. We talk about the meds. In the beginning when I was put on something, I would go the library and look them up. I would then ask questions. He would always answer them. He wanted to put me on Enbrel. After watching the video with my family, we all said heck no. That generic drugs are coming out for some of the meds I’m on, is helping.