Twice this week, the Centers for Disease Control and
Prevention has pointed to the harm caused by aberrant and inappropriate
prescribing by physicians.
First, the CDC reported Monday that doctors are a primary
source of narcotic painkillers for chronic abusers at the highest risk of
overdoses. Physicians edged out even
family, friends and drug dealers. More than 16,000 people died of narcotic
overdoses in 2010, the most recent year for which data is available, the CDC
On Tuesday, the public health agency said that it found vast
differences in the use of antibiotics among different hospitals’
medical/surgical wards. Doctors in some hospitals prescribed three times as
many antibiotics as those in other hospitals. The CDC also said that in about one-third
of cases, prescriptions for the antibiotic vancomycin included a potential
error – either it was prescribed without proper tests or evaluation, or
given for too long.
For more than a year, ProPublica also has been looking at physicians’
prescribing practices. Our reporting has showed striking
differences in how doctors prescribe drugs, with some ordering massive
quantities of risky or potentially inappropriate medications in Medicare’s
prescription drug program. Despite collecting data on every prescription, the
government has done little with the information. Our Prescriber Checkup tool allows the
public to look up individual physicians and compare their drug choices in
Medicare’s program, known as Part D, to others in the same specialty and state.
We talked to Dr. Thomas Frieden, the CDC’s director, to help
put the agency’s two recent reports in context and to ask how doctors can compare
their prescribing to their peers and what the role of consumers should be.
This conversation has been edited for length and clarity.
Q. The CDC issued two reports this week, on opioid abuse and
antibiotic prescribing. While they’re not explicitly linked, there does seem to
be a common thread between them, namely that inappropriate prescribing by
physicians can cause patient harm. Do you agree?
A. I think I would frame it a little bit more broadly. I
think although there are certainly many areas in health care where we’re
under-medicating and not using enough medications, more commonly we’re
overmedicating. I think you can see that in antibiotics, you can see it in
opiates, you can see it in some of the psychoactive drugs. There’s an old
saying called the “inverse care law,” and the inverse care law says that the
people who need care the most get it the least and vice versa. It’s not about
more or less treatment; it’s about better treatment.
Q. One problem I see is that doctors have no real way of
knowing if their prescribing practices are aberrant compared to peers. Is there
a way for them to benchmark their habits?
A. We are now recommending that every single hospital in the
country have an antibiotic
stewardship program, and that this program include at a minimum seven core
elements. And those elements are leadership, accountability, drug expertise,
tracking, reporting and educating. Reporting means regularly reporting to staff
on prescribing and resistance patterns and steps to improve. An individual
doctor may not be able to know, …read more