The politics of prescription drugs, Part One

Here are two recent news stories about prescription drugs. The first story discusses a recent study finding that 15 million U.S. citizens--many of them teenagers--abuse prescription drugs. The second story reports on research that has found that many doctors and pharmacists have limited training when it comes to knowledge about and the prescription of these drugs.

Although each story is disturbing in its own right, they are especially disturbing when put together. We may have a situation where health care professionals are unable to deal effectively with this prescription drug abuse and/or a situation where health care professionals' lack of training regarding these drugs have helped to facilitate this abuse.

Given that the pharmaceutical industry is one of the most profitable business sectors globally, and given that it is very difficult for health care professionals to keep up with the large and ever-increasing array of prescription drugs on the market, it is no wonder that many of these professionals lack proper training.

There is also the issue of direct-to-consumer (DTC) ads. Although they currently dominate advertising space on TV and in magazines, DTC ads are actually a relatively new phenomenon. In their current incarnation, they were legalized by the FDA in 1997. Such ads, coupled with increased patient participation in health care decision-making, have led to a dramatic increase in patients asking their doctors to prescribe them drugs for all kinds of ailments. And according to a slew of recent studies, many MDs are granting the wishes of these patients, even in cases where the MDs would not necessarily have prescribed the drugs had the patients not asked for the prescription themselves. (For more information about DTC ads, FDA regulation of them, and the studies conducted to determine the impact of DTC advertising on consumer demands and doctors' prescription-writing practices, see this excellent 2002 GAO report)

So what does this all his mean for the problem of patient drug abuse? Assuming that doctors are not able to keep up with the ever-increasing number of prescriptions drugs on the market, they may not be fully equipped to deal with the growing number of patients asking them for prescriptions. This situation is only worsened by the fact that due to HMO and other institutional policies, many doctors only have 10-15 minutes to meet with their patients. In most cases, this is not enough time to do a comprehensive examination to determine whether such drugs are necessary and/or if there are alternative medical treatments. Thus, in light of these multiple factors, it may be easier for the MD to just prescribe the drug and move on.

To sum up: although patient abuse of prescription drugs is a problem in its own right, it may be also a symptom of a much bigger set of complex problems related to medical training, HMO policies, insurance companies, FDA policies, and the ever-increasing expansion and power of the pharmaceutical industry.