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Why You Should Care About the Drugs Your Doctor Prescribes

Patients currently have to rely on trust that their doctors prescribe them the right drugs. Our new tool, Prescriber Checkup, for the first time allows patients to see how health care providers stack up with peers.

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This article was co-published in the Op-Ed pages of the Los Angeles Times.

Your doctor hands you a prescription for a blood pressure drug. But is it the right one for you?

You’re searching for a new primary care physician or a specialist. Is there a way you can know whether the doctor is more partial to expensive, brand-name drugs than his peers?

Or say you’ve got to find a nursing home for a loved one. Wouldn’t you want to know if the staff doctor regularly prescribes drugs known to be risky for seniors or overuses psychiatric drugs to sedate residents?

For most of us, evaluating a doctor’s prescribing habits is just about impossible. Even doctors themselves have little way of knowing whether their drug choices fall in line with those of their peers.

Once they graduate from medical schools, physicians often have a tough time keeping up with the latest clinical trials and sorting through the hype on new drugs. Seldom are they monitored to see if they are prescribing appropriately — and there isn't even universal agreement on what good prescribing is.

This dearth of knowledge and insight matters for both patients and doctors. Drugs are complicated. Most come with side effects and risk-benefit calculations. What may work for one person may be absolutely inappropriate, or even harmful, for someone else.

Antipsychotics, for example, are invaluable to treat severe psychiatric conditions. But they are too often used to sedate older patients suffering from dementia — despite a “black-box” warning accompanying the drugs that they increase the risk of death in such patients.

The American Geriatrics Society has labeled dozens of other drugs risky for elderly patients, too, because they increase the risk of dizziness, fainting and falling among other things. In most cases, safer alternatives exist. Yet the more dangerous drugs continue to be prescribed to millions of older patients.

And, as has been well-documented by the Los Angeles Times and others, powerful painkillers are often misused and overprescribed – with sometimes deadly consequences.

As reporters who have long investigated health care and exposed frightening variations in quality, we wondered why so much secrecy shrouds the prescribing habits of doctors.

The information certainly isn’t secret to drug companies. They spend millions of dollars buying prescription records from companies that purchase them from pharmacies. The drugmakers then use the data to target their pitches and measure success.

But when we tried to purchase the records from the companies that supply them to drug manufacturers, we were told we couldn't have them — at any price.

We next turned to Medicare, a public program that provides drug coverage to 32 million seniors and the disabled and accounts for one out of every four prescriptions written annually.

We filed a Freedom of Information Act request for prescribing data. After months of negotiation with officials, we were given a list of the drugs prescribed by every health professional to enrollees in Medicare’s prescription drug program, known as Part D.

What we found was disturbing. Although we didn’t have access to patient names or medical records, it was clear that hundreds of physicians across the country were prescribing large numbers of dangerous, inappropriate or unnecessary drugs. And Medicare had done little, if anything, about it.

One Miami psychiatrist, for example, wrote 8,900 prescriptions in 2010 for powerful antipsychotics to patients older than 65, including many with dementia. The doctor said in an interview that he’d never been contacted by Medicare.

A rural Oklahoma doctor regularly prescribed the Alzheimer's drug Namenda for patients under 65 who did not have the disease. He told us it was because the drug helped calm the symptoms of autism and other developmental disabilities, but there is scant scientific support for this practice.

Among the top prescribers of the most-abused painkillers, we found many who had been charged with crimes, convicted, disciplined by their state medical boards or terminated from state Medicaid programs for the poor. But nearly all remained eligible to prescribe to Medicare patients.

If you or a loved one were a patient of one of these doctors, wouldn’t you want to know this?

We have now taken the data and put it into an online database that allows anyone to look up a doctor's prescribing patterns and see how they compare with those of other doctors.

This information is just a start. It can't tell you if your doctor is doing something wrong, but it can give information that allows you to ask important questions.

For instance, why is your doctor choosing a drug that his peers seldom do? Does your doctor favor expensive brand-name drugs when cheaper generics are available? Has your doctor been paid to give promotional talks for drug makers?

And we’d like to see the day when all prescribing by all health professionals – not just in Medicare – is a matter of public record.

It’s not only patients who benefit when medicine is more transparent. Doctors too can gain by comparing themselves to their peers and to those they admire. Clinics can see how their staffs stack up. And researchers can track patterns and examine why doctors prescribe the way they do.

One doctor told us that after studying our online database, he cornered his colleagues and peppered them with questions about their prescribing. Most, he said, were surprised when he told them their drug tallies.

Many aspects of doctors’ practices remain private. The number of tests they order and procedures they perform. The number of times they make mistakes. These data could help inform the public, too.

In the meantime, arming yourself with prescribing information allows you to be more active in your health care or that of an aging or disabled loved one.

This is an excellent piece of journalism and as healthcare becomes more transparent other issues will emerge. Many doctors are no longer in practice for themselves but belong to larger provider organizations. Because many drugs that are prescribed do more harm than good it is only a matter of time before cost conscience hospitals (audited by large employers) begin to see trends and calculate the additional cost of healthcare due to drugs that maim and kill. As a result drugs that lack efficacy will not be utilized like they are today.

ERISA governed plans which have traditionally favored employers and have been litigated to nth degree are now going to work to protect employees with the same mechanisms it used to protect their profits in the past.  The pharmaceutical companies are going to be the losers and it’s about time.

Bruce J. Fernandes

July 16, 2013, 4:08 p.m.

I have to say that a Kaiser Foundation or other large organization that has the professional resources to have professionals dedicated to monitoring and keeping current on drug interactions seem to do much better than the traditional one or small practitioner office.

I have had three instances in my life where I was contacted and told that a conflict existed between two meds and to immediately stop taking one med and throw it away immediately.  No harm had been done to me so no foul either.

Just as important is the issue or proper tapering off of drugs.  I had one doctor tell me to stop a med immediately recently.  I knew better and should contact the specialist who gave me a tapering schedule.

My best friend’s son just graduated from pharma college in Las Vegas.  That is the biggest challenge pharmacists are now confronting and we have to hope that our pharmacist is also a line of defense in the event our primary and/or specialists miss something in prescribing.

The VA medical system is the only US health care institution that can negotiate prices with big pharma. So what gets prescribed elsewhere will be in line with big pharma’s philosophy.

John V. Lesko

July 16, 2013, 5:36 p.m.

If you are going to do a search then please do it correctly.  Your search does not work.  Just look at the example that you give, i.e., first name first.  So, search results are with first name!  Even when one puts last name in, as I just did for 4 different doctors known to have Medicare patients, the results are impossible to use.

Don’t worry about what “your” doctor will do. Soon enough “the” doctor
(Obamacare) will control the pharmacy (cheapest, least side effects).
Whe you want the new meds, YOU will pay for them. Check any VA hospital now. Only APPROVED medications are allowed.
The journalists will have no axe to gring then.

Richard Lehner

July 17, 2013, 5:29 a.m.

This is the third article from various sources that check up on doctors. The concept is very cool but also scarey how much is on someone on the web. Sign of the times I suppose. I’m just glad in each one my doctor comes out great! I always knew he was great and I refer him to others, nice to have the numbers to back it up I guess. Peace and coexist

It’s all well and good to empower the patients with this sort of database, but in the ideal world, doctors should be using it to check up on themselves.

When I realize I’m doing something different from my own colleagues, it’s a sure sign that I have something to either learn or teach.  Imagine doctors who treated their jobs the same way.  Doctors who acted like scientists instead of technicians (discussing weirdness and failures openly, rather than hiding behind status) would go a long way to solving some of the core problems of healthcare, I think.

Bruce J Fernandes

July 17, 2013, 9:09 a.m.

I saw someone comment about doctors checking up on themselves.  In large provider organizations that is probably next to impossible.

I recently had a elective surgery.  I deal with my main primary provider and I have to see two outside specialist groups.  The elective surgery has corrected so many problems the number of times I will see the outside groups will eventually end.

In the meantime, even though I was referred by my primary critical information between the three is not being conveyed.  Systems are not compatible to send/receive information.

It is up to me meaning up to the patient to take charge once it becomes clear their care is not being coordinated.  I coordinate my appointments to coincide with blood work and I march the blood work and hand deliver to each practitioner.

My personal quality of care has gone up because of the surgery but it only gets better when I feel in charge and am getting the best medical input from my professionals because they are getting the information roundtable info directly from me.

I think all of us need to take personal responsibility for coordinating our own care regardless.  I am sure everyone has shown up to an appointment with one practitioner that was contingent on info from another and you get to that appointment and the info from the primary was not received by the other professional.

If we casually accept the system is working to our benefit that is our first mistake.  Let’s stop making that mistake and take charge for ourselves and learn along the way from all of the professionals involved in your case making critical decisions affecting you.

Excellent investigative work. Much needed information not only for caregivers who are taking care of aging parents or disabled partners, but also for doctors who believe in intelligent, effective and ethical use of drugs for treatment.

We need to set up an award for doctors and medical practitioners who treat patients not only competently…but ethically as well. This issue would be considered vital in such an evaluation.

As the drug industry grows so must these kinds of transparency and accountability.

These kinds of thoughtful articles should also go global, and help emerging economies and their population better monitor their medical practice and their growing drug industry.

Congratulations ProPublica…look forward to other such pro-active useful articles.

Doctor bashing article.
When working for a large clinic, my hands were quite tight by insurance companies to prescribe the right medications, despite guidelines. this process required a lot of paper work and appeals. Most of the time despite the appeals the insurance still will refuse the medication needed for the patient, I guess hoping the patient would not use the medication at all despite the doctors’ recommendations, thus saving the insurance money. I am glad pro-publica used the freedom of information act, however every drug representative has this data at hand.
Maybe pro-publica can do some leg work and check with physicians how difficult it is to do the right thing for the patient because of the insurance pressures and or the corporate health organizations pressures. Check with the emergency department physicians how many times they receive complains from their managers that their patient satisfaction is a problem because they declined to prescribe narcotics or unnecessary antibiotics! check with the primary care doctors and midlevels as well or hospitalist on the pressure there is from administration to give and prescribe pain medication because of concern about patient complaints and clinic/hospital ratings!
Or when patients are demanding procedures because of advertisements such as on TV of cosmetic procedures.
Physicians are being hammered again and again. I don’t deny they are those who have poor experience with the physician they encountered.
Again it is not enough to study the papers but please get out and check how health organizations and their administrators are functioning.

Amelia you should join the Patient Harm Facebook group.  ProPublica is looking for professionals and their viewpoint to add to the discussion.
I am a member and was injected for profit 12 times with the very toxic gadolinium based contrasting agents and eleven times with Omniscan GE’s product.  In a recent trial a study was retracted because the researcher wasn’t given information about a prior study which showed that GE’s product was more toxic than the others and accumulated more in the livers and kidneys of mice.  In the retracted study the researcher observed that 25% was missing in collected urine from patients injected with Omniscan.  GE’s predecessor told the researcher that patients sweated it out. 

Personally I think that insurance companies now and in the future will play a role in stopping toxic and harmful drugs that maim and kill and are approved by the FDA because of rigged clinical trials and a drug approval process both post and pre-approval has been corrupted.  Even after all that came out at the trial of a man that was diagnosed with nephrogenic systemic fibrosis from Omniscan it is still being injected into people.  Everyone involved in the MDL 1909 agrees that gadolinium in its free toxic state in the body is toxic to the human body, that was in Judge Polster’s ruling.  There is no dispute and yet Omniscan remains on the market.  I myself retained toxic levels of gadolinium and it was found in multiple tissue samples including one from my breast.  Here’s what Judge Polster had to say about gadolinium retained in the body. 

“The free gadolinium theory passes reliability muster under Daubert because it is based on research conducted by scientists and doctors performing animal studies, in vitro studies, in vivo studies, human clinical studies and retrospective case studies along with review of the relevant published scientific and medical studies; the theory has been subjected to publication and peer review; the theory has been generally accepted in the relevant scientific and medical community.”

The medical profession, by being complacent has brought this on and nothing you say will convince me that you and your profession don’t need to be watched somehow, someway.  The FDA is not doing its job and insurance companies, large employers and the government must pick up the cost of the harm your profession causes therefore they have a vested interest in keeping the patient population healthy.

Its not just doctors its also Neurologists   aswell with MS who do the same.  Many have promoted many deadly MS drugs that   cause PML and many have   died on. MS is full of GREED and CORRUPTIONS   to the core with so many who promote the deadly drugs. Its sick to the core . Someone must scrutinise   this soon. Theres   so many involved and part of aswell .

LYNN HEAL you should read Swaminathan’s patent on gadolinium toxicity and MS patients.  From page 11.

“Patient afflicted with the autoimmune disease multiple sclerosis may also be at greater risk of developing gadolinium toxicity.  Magnetic resonance imaging is often used to track the progression of multiple sclerosis by visualizing inflammatory multiple sclerosis lesions.  Gadolinium chelates are typically used to show permeability of the blood brain barrier in these inflammatory multiple sclerosis lesions.  Because gadolinium localizes in these inflammatory lesions of the central nervous system, multiple sclerosis patients exposed to gadolinium may experience iron-mediated transmetallation reactions in these lesions.  Such multiple sclerosis patients are more likely to experience progression of their neurodegenerative symptoms – and thus a higher degree of morbidity – Such patient can be expected ot have an accelerated rate of mortality. “

http://www

scribd.com/doc/99351033/dr-swaminathan-nsf-drug-patent-to-prevent-nano-gadolinium-toxicity-gasf-nsf-nfd08066862

Why on earth are neurologists still recommending annual MRIs for MS patients.  I think you are right Lynn something needs to be done about it.

This article is part of an ongoing investigation:
The Prescribers

The Prescribers: Inside the Government's Drug Data

Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.

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