Wednesday, November 01, 2006

Free antibiotics

You've probably have heard what Wal-mart is doing with the price of prescription drugs - Rob even talked about it yesterday.

Now, to up the ante, regional stores/pharmacies are offering FREE drugs. What do I mean? In last Friday's Columbus Dispatch, there's a story talking about Mejer and Giant Eagle (regional pharmacies), in selected parts of Ohio, offering selected free antibiotics.

Don't get me wrong, you still need a prescription from a doctor (or other health profesional with prescription writing privileges - How politically correct is that?) for this. But, apparently, you bring the prescription to the pharmacy, and BANG, here's your antibiotic - now go and feel better.

From a cost standpoint, I think this is a good thing. Generic drugs are ridulously overpriced! Some of my patients have told me that rarely the name brand drug is the SAME price as the "generic."

From a patient care standpoint, I see this as a real problem. Wal-mart had the right idea, kind of, with offering some discounted chronic medicines - like blood pressure medicines and antidepressants. But, offering antibiotics?

Many studies have shown that you don't need an antibiotic every time you get a respiratory infection. And, I even admit, if I'm on the fence for a diagnosis, I err on the side of possibly a bacterial infection, and I prescribe the antibiotic.

For years, doctors have been warned to "just say no." And, we're seeing the complications of these decisions - mainly drug resistant infections.

So, docs out there, have the courage to stand your ground and explain the difference between bacterial and viral infections. And, if you're a patient, try to hold back your wrath if your doc doesn't give you that antibiotic and wants you to have the viral infection "run its course, because antibiotcs wouldn't help anyway."


Mother Jones RN said...

You bring up a very good point. We overuse antibiotics, and while these free medication programs will be very helpful to those who really need them, it will encourage patients to overuse antibiotics. I have patients who can't afford their psych medications, so they stop taking them. The next thing you know, they are back in the hospital. I've also taken care of patients that can't afford blood pressure medications. They stop their medications, stroke out, and end up in long care facilities. It sounds like these are great programs, but I wish they would offer other medications as well.


Anonymous said...

I hate taking medications, any kind.
If have a problem I drink more water and special teas and wait for it to go away… 90% of times it goes away if not then I go to the doctor!

ladybug said...

hey doc,

i'm curious...having survived Micro this summer: do you do a culture and sensitivity when you have someone with a bacterial infection so you can prescribe the most effective antibiotic?

i was shocked when my instructor offered that this 'should' be done each time, and how it would impact the drug resistance even more, by using the right med for the right bug. i am there pressure not to make the patient have more "testing" than they want/think is necessary? cuz you know, if they pout when you wont give them an antibiotic right away, they will pout if they have to have a culture done.

Midwife with a Knife said...

I shudder to think of all of the patients that will ask for antibiotics for all of their colds now that they're Free! at Walmart.

Brittney said...

I can see the good and the bad behind these "free antibiotics." Since I am taking microbiology at the moment, I have learned a lot about resistence and how it is thought to occur. I'll agree with you that they are over prescribed, and that some people will ask for them when they aren't needed.

But, I also see how this can help. I'm living without health insurance, and being a college student I don't have a lot of money. I spend a lot of money on the medication, and I'd have to pay three times as much if I didn't qualify for the assitance programs run by the pharmacutical companies. I've paid a couple hundred bucks this year for antibiotics, and had to cut back on groceries to afford them.

NeoNurseChic said...

Similar to Brittney's comment there, I must say that I got furiously mad at my best friend at Penn State when she went a semester without health insurance. I forget the whole reasoning behind it at this point, but there was some reason why she didn't have it. I remember her getting sick, and she was prescribed antibiotics, and the price for the one prescription was well over $100! She said she couldn't afford the antibiotics at that price, so she ended up just trying to ride it out. This is totally not uncommon for college students. As you can see, there are 2 examples right here alone!

So I don't think that college students necessarily run out to get scripts for antibiotics just because they're now free, but maybe some of them will actually take their meds when they're prescribed instead of deciding that they need to spend their loan money on something else!! (Groceries are always a good choice, but I'm thinking of the numbers of college students who will spend the $100 on beer rather than that course of antibiotics...)

On a different note - this morning, this one resident came in coughing and sneezing rather loudly. We finally asked him if he was okay and asked if perhaps he should be at home instead of at work. He said that he was on antibiotics. So I asked him later if he had been prescribed antibiotics for the common cold...almost jokingly. He said he prescribed them for himself. We all paused for a second and asked if that wasn't illegal? He said that he didn't REALLY prescribe them for himself. He had them left from some other time when he didn't take his course of antibiotics. He knew that he couldn't exactly say, "I'm sorry - I can't come to work in the NICU today because I need to go to the doctor and get some antibiotics." So instead he decided to take old antibiotics for what may just be the common cold.

Do as I say...not as I do...? Heh heh...

Just some interesting observations of various angles on the abx issue! :)

Anonymous said...

I agree.

It's me, T.J. said...

I wonder what started the sudden and drastic price cuts in these drugs in the first place.

There's got to be some driving force behind this, but what it is I haven't a clue.

Does anyone else?

I believe that antibiotics are over prescribed in many cases; but at the same time, I also feel that many times people go to the doctor unnecessarily as well.

And since they do show up in the doctor's office, I think that pressure is then applied to the physician to make sure that the patient leaves the office with a prescription in their hand. Mostly because the patient expects to leave the 'establishment' with *something*.

Kind of like a "thanks for your business" kind of thing.

Of course, I'm sure that Dr. A doesn't do that.


Dr. A said...

Ladybug, This is a good point. Testing to confirm diagnosis is always a good idea. However, testing always brings in the factors of false positives, false negatives, and all that statistical stuff you probably learned about.

Plus, getting an adequate sample can be challenging. Sinus infections are common around here. But, I can't think of anyone who can get a good sample of sinus fluid except to drill a hole into the maxillary sinus. Ideally, to confirm the bug for pneumonia. But, to get a good and adequate sputum culture is challenging.

I do agree with you that eventually, no antibiotic should be used unless a diagnosis can be confirmed and culture obtained.

ladybug said...

funny thing, doc... in the class this summer, our prof told ua we always had a right to ask them to do a culture, and even tho i would say i am assertive in my care, i was STILL intimidated to as the doc i was seeing to do a culture so we could prescribe the proper antibiotics. of course i think this had more to do with the doc than me wanting to "bother" someone.

Jenny said...

Oh wow! How do we get them to do this for anti-rejection drugs?! I'd sure like to pocket the $2,400 a month habit my kid has rather than actually PAYING for it! ;) Perhaps if we had a lot more people demanding anti-rejection drugs...of course that'd mean we'd have to get a lot more people organ transplanted...we'd need more donors...I wonder how many celebs we could get to sign up to be organ donors to make it the new "it" thing and then everyone would jump on board and I could get free drugs for my kid.
Sorry, long day. ;)

Anonymous said...

sorry a bit late in catching up on blogss.. but seriously.

Who is the doc and spent all those years in med school?... i go in they always ask what i think is wrong with my kids.. i tell them the symptoms and what I think could be... as a mom you learn real fast ...but if the doc says no.. i say ok.. cool so long as you checked im good. ya know?... gesh people.. really who is the doc?

UK Community Pharmacist said...

I can't really see the point of this scheme. People with scripts for antibiotics generally don't feel too good and typically aren't bothered about the cost - witness the growth of the cold and flu remedies that can be taken without water; people are happy to pay for these.

Secondly, antibiotics don't tend to be particularly expensive. In a normal day I might dispense amoxicillin, penicillin, cefalexin, metronidazole, erythromycin, co-amoxiclav and trimethoprim. Now none of these are particularly expensive, so either pharmacies are ripping patients off, or doctors are prescribing off the wall antibiotics.

Anonymous said...

I think this move by Walmart will lead to less prescription abuse. Seriously, doctors, when you see a patient, do you ever ask if other people in the patient's family have the same symptoms? Do you know what the financial situation is of your patient? Do you realize that lower income patients routinely divide their medications with family members because the family could afford to send only one person to the doctor and get only one prescription filled? Now figure out a way to get the whole family seen at a discount, and you can stop worrying that individual patients won't take all they have been prescribed.

Anonymous said...

I am a mom with 6... yes 6 children, one of which is in college. I do not do antibiotics for every little problem that comes along. But it is nice to know that I can save a little on my medical budget when we do have to get antibiotics. With that many germs shared in the house... it is nothing to spend 200 if we have to do dr. and meds. Since 4 out of 6 kids are asthmatics. I really pray that people do not abuse this program. I enjoy the bonus/help this offers to my budget.

Anonymous said...

I have recurrent cellulitis,I don't understand why I'm not on antibiotics for longer,than just 10 days. You'd think they'd want me to stay out of the hospital? These free antibiotics sure would help me,if I need them long term.