Welcome to the RightCare Weekly, a newsletter that will help you stay on top of all the important news in the ongoing quest to move the U.S. health care system toward the right care. We’ll bring you the most important stories, news articles, and opinion pieces of the week, along with our interpretation of why they’re important and what they mean for patients, doctors, and communities.
The New York Times reports growing concern among doctors about the treatment of toddlers for ADHD. A recent study suggests that over 10,000 two- and three-year-olds are prescribed ADHD medications such as Ritalin and Adderall, even though these drugs are not approved or recommended for children under 4 years old. While in rare cases the use of these medications may be appropriate, for the most part those prescriptions amount to “winging it,” according to one doctor quoted in the story. Behavioral pediatrician Dr. Doris Greenberg states that in many of these cases there are “overwhelmed parents who can’t cope and the doctor prescribes as a knee-jerk reaction. You have children with depression or anxiety who can present the same way, and these medications can just make those problems worse.” The overall picture is a deeply disturbing example of what happens when overdiagnosis becomes overmedication.
As reported in the LA Times, a new JAMA study suggests that 7 out of 10 patients treated for acute bronchitis are being prescribed antibiotics, despite the fact that nearly 40 years of clinical research has shown that antibiotics are not effective in treating acute bronchitis. This is troublesome not only because patients are paying for prescription drugs that they do not need and that are not effective, but also because overuse of antibiotics is causing a rise in drug-resistant pathogens, possibly leading to what the World Health Organization describes as a “post-antibiotic era.”
A USA Today story published this week explores the issue of prescription drug misuse among seniors. According to the Substance Abuse and Mental Heath Services Administration, an estimated 132,000 seniors are misusing or dependent on prescription pain relievers. Those addictions are fueled in part by what the article calls the “medicate-first” culture: doctors want to be able to help people, and often see patients as just wanting a prescription for their problems (even if that prescription is unlikely to help). Doctors also worry about stigma: “people don’t want to take away a 70-year-old’s medications.” However, in many cases of polypharmacy, where a patient is taking several drugs at the same time, it’s safer to stop some of them – taking fewer drugs can help patients avoid the risk for falls and other serious interactions and side effects.