Study
Attributes Increase to Growing Number of Seniors, Aggressive
Marketing by Drug Companies
By
Susan Okie
Americans who visited a doctor's office
in 1999 were far more likely to receive more than one drug
than U.S. patients were in 1985, a new government survey of
physicians shows. The increasing
reliance on prescription medicines spanned all
ages of patients and almost all classes of drugs, with the
notable exception of antibiotics.
About 66
percent of visits
to doctors in 1999 resulted in patients receiving a medicine
or a vaccine, compared with 61
percent in 1985.
But those given prescriptions -- especially the elderly --
were much more likely to get multiple drugs, said Catharine
W. Burt, chief of the ambulatory care statistics branch at
the National Center for Health Statistics, which conducted
the survey.
The increase in prescribing "is just
a lot more than we would have expected just from the aging
of the population," Burt said.
The survey's findings suggest that drug
advertising -- including the promotion of drugs directly to
the public -- may be contributing to the trend.
"The
ones that are heavily marketed are, in fact, heavily prescribed,"
Burt said.
Direct-to-consumer advertising has made
a huge impact on sales of medications which are not always
the best medications for people to take.
Spending for prescription drugs is the
fastest-growing category of health care expenditures.
It is a major political issue for the
Bush administration, which has proposed reducing drug costs
for the elderly under the federal Medicare program, as well
as a concern for employers and other consumers facing rising
health costs.
The new information comes from a survey
of a representative national sample of office-based physicians.
It shows that medication (usually a prescription) was provided
at 501 million
of the more than 756 million
visits to the doctor that Americans made
during 1999.
The survey asked doctors how many drugs
-- and which ones -- were prescribed or recommended during
visits. In 1999, 146 drugs were prescribed per 100 visits,
a 33 percent increase over the 1985 figure of 109 drugs per
100 visits.
Drugs to treat heart, circulatory and
kidney diseases were the top category. But the most frequently
prescribed drug, Claritin, is for allergy symptoms. Also among
the top 10 were Lipitor, a cholesterol-lowering medicine;
Prilosec, a drug for heartburn and for stomach and duodenal
ulcers; and Celebrex, a new drug for arthritis.
The survey examined use of 104 drugs approved
by the Food and Drug Administration between 1997 and 1999
and found evidence suggesting that marketing was closely related
to frequency of prescribing.
Drugs that were heavily
advertised were much more likely than others to
be in the top 20 percent of new drugs prescribed. It found
that four new drugs -- Celebrex and Vioxx for arthritis, Singulair
for asthma and Detrol for overactive bladder -- accounted
for 12 percent of the estimated $17 billion increase in drug
spending that occurred between 1998 and 1999.
"Manufacturers spend money on promotion
to the extent that they believe that there's a good market,"
said Nancy M. Ostrove, deputy director of the FDA's division
of drug marketing advertising and communication. She said
it is impossible to say
whether advertising causes prescribing or whether
increases in both are driven by consumer demand.
Burt said antibiotic prescribing declined
by 14 percent in 1999 compared with 1985 -- potentially good
news because overprescribing
of antibiotics for infections that do not require
them has been blamed as a factor in the rise of bacteria resistant
to the drugs.
Washington
Post July 18, 2001; Page A02
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