Be Careful What You Ask For

A recent study confirmed that when it comes to writing prescriptions, many physicians are accommodating and somewhat pliable when it comes to patient requests for medications promoted through media sources.

The study underscores what the pharmaceutical companies already knew - advertising works! From a patient's perspective, failure to respond to such a request on the part of the physician may be construed as withholding the "best" treatment, trying to save the insurance company money, or apparent ignorance of what the latest and greatest treatment happens to be for a particular condition.

While one hopes that we are careful to give people medications that are not harmful, sometimes the writing of a prescription by a physician can be a punctuation point of sorts designed to bring an encounter to an end absent consideration of all the implications.

Sadly, and more often than one might think, what was designed to cure can also kill when given in unknowing combination with current prescriptions or herbal and other "natural" medications. Every year, adverse drug events (ADE's) kill 100,000 Americans and injure 2.1 million more! Potential causes of ADE's are:

• Incorrect dose
• Lack of dosing modification for renal or liver failure, congestive heart failure
• Unrecognized drug interaction
• Therapeutic duplication
• Inadequate knowledge about new drugs
• Sound-alike medications
• Lack of drug information available at the point of care
• Unrecognized contraindication
• Misinterpretation of written orders
• Increased demands on nursing and pharmacy; 'not having the time to look things up'
• Improper administration
• Increasing complexity of medical treatments

The annual national cost of drug-related morbidity and mortality is estimated to be as high as $76.6 billion. About $47 billion of that is related to hospital admissions associated with drug therapy or the absence of appropriate drug therapy. By comparison, the cost of diabetes care has been estimated at $45.2 billion.

The predicament can be further complicated when more than one physician or other health care provider are in the mix. Unknowingly, multiple medications in concert with herbal and other over-the-counter cures can combine to produce toxic and catastrophic consequences that are often only discovered after the damage has been done.

It is far better to advise any health care provider of all the pills that you are taking, including prescribed medications and any other substances that you are ingesting, both legal and illegal. Alcohol can often be a hidden contributor to adverse events - so come completely clean if you consume alcohol regularly and specify the amount ingested.

There are some basic steps that anyone can take to reduce the risk an adverse drug event.

1. Keep an up-to-date record of all your medications and carry it with you at all times.
2. When a doctor or other provider is about to prescribe or recommend a new medication or treatment, advise that person of all the medications that you are already taking.
3. Talk to your pharmacist about potentially dangerous interactions.
4. Clean out your medication cabinet at home and get rid of all unused and expired medications.
5. Consult one of several publicly available web sites with accessible drug interaction programs, such as the Drug Interaction Checker from Discovery Health or the similar tools from Drug Digest or the Center for Drug Safety (this one requires a user name, password, and e-mail address).

Despite the claims of pharmaceutical companies, there is not a pill for everything. Don't be too quick to look for an answer from a "new" medication.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.