GPs prescirbing drugs inappropriately

Taco Chips

This is obviously anecdotal so YMMV but I think the stereotype of the passive doctor writing a script for just about anything is grossly over exaggerated. In my time on placement in hospitals anyway I've seen nothing but total vigilance over drug prescription. More docs leaning on the side of super caution (as it should be) than anything. And antibiotic stewardship is taken very seriously with medical microbiology having close input to nearly every inpatient case I've seen. I've heard rumours etc.. about students being on study enhancing medication but never seen any real evidence of it, and the rumours themselves tend to come from North Americans where that kind of thing may be a bit more common. I'm open to correction on this if anyone has stats for the situation in Ireland but from my experience docs are highly attentive about all prescriptions here nearly all of the time.

Kurtosis

OP what would you consider inappropriate prescribing to be? I think any discussion like this needs to be framed with what inappropriateness constitutes. I would think of it as either:

- prescribing a medicine to someone who does not have an evidence-based/licensed indication for it or
- prescribing a medicine where the harms outweigh the benefits or there is an alternative option with a better risk/benefit ratio.

With regard to beta blockers for anxiety, it is a licensed indication as has been mentioned and they certainly would be safer than pharmacological alternatives like benzodiazepines. So if a person does suffer from presentation anxiety and their GP is confident of this, I think it would be appropriate to prescribe a beta blocker. Of course there are going to be situations where a person may be deceptive to try and obtain a drug but if we are talking about the general case I can't see any problem. (This is from a non-doctor perspective)

Taco Chips

Taco Chips wrote: »

This is obviously anecdotal so YMMV but I think the stereotype of the passive doctor writing a script for just about anything is grossly over exaggerated. In my time on placement in hospitals anyway I've seen nothing but total vigilance over drug prescription. More docs leaning on the side of super caution (as it should be) than anything. And antibiotic stewardship is taken very seriously with medical microbiology having close input to nearly every inpatient case I've seen. I've heard rumours etc.. about students being on study enhancing medication but never seen any real evidence of it, and the rumours themselves tend to come from North Americans where that kind of thing may be a bit more common. I'm open to correction on this if anyone has stats for the situation in Ireland but from my experience docs are highly attentive about all prescriptions here nearly all of the time.

What was the meropenem use like? Micro seen everybody?

Xeyn

To be fair I don't see any recreational benefit for beta blockers [i am willing to be corrected on that] Ritalin or benzodiazepines on the other hand - yes, so not sure why anyone would purposefully be deceptive to obtain them.

RobFowl

Xeyn wrote: »

To be fair I don't see any recreational benefit for beta blockers [i am willing to be corrected on that] Ritalin or benzodiazepines on the other hand - yes, so not sure why anyone would purposefully be deceptive to obtain them.

You haven't lived ....

echo beach

Xeyn wrote: »

To be fair I don't see any recreational benefit for beta blockers [i am willing to be corrected on that]

Depends what recreations you indulge in. They may improve your performance at any activity that requires a steady hand, e.g. snooker, darts or clay pigeon shooting.

Xeyn

Cheers lads, that's my weekend sorted then!

BetterThanThou

I have no experience in pharmacology at all, bar some small research I've done on my own time, but I'd always assumed beta blockers were simply to treat tachycardia, never heard of them used to concentrate or for any other reason, though I may be wrong. As far as ritalin is concerned, mental health is something quite easy to lie about, and no doctor can really distinguish lies from the truth in that area, it's simply a case of having to take what the patient says as fact. There's always going to be people abusing drugs like this, and you can't really deny it to them without denying it to people who actually need it.

partyatmygaff

Though they can be used for tachycardia, i'd have thought their most common use would be in treating heart failure, dysrhythmias and hypertension.

They're not approved for treating anxiety but they're occasionally used off-label for treating some symptoms of anxiety such as tremor, increased heart rate and so on. The more lipophilic beta blockers like propranolol cross the BBB (to the point that they may cause unusual dreams or nightmares) so there may be some possible reduction in psychological symptoms of anxiety with long-term use. This is a bit old but it and its related articles may be a good read: http://www.ncbi.nlm.nih.gov/pubmed/2905981

Ethically, contraindications aside, it's much less risky than going down the road of benzos. I'd have no issue dispensing a script for beta-blockers for anxiety providing it's suitable for the patient.

steddyeddy

Taco Chips wrote: »

This is obviously anecdotal so YMMV but I think the stereotype of the passive doctor writing a script for just about anything is grossly over exaggerated. In my time on placement in hospitals anyway I've seen nothing but total vigilance over drug prescription. More docs leaning on the side of super caution (as it should be) than anything. And antibiotic stewardship is taken very seriously with medical microbiology having close input to nearly every inpatient case I've seen. I've heard rumours etc.. about students being on study enhancing medication but never seen any real evidence of it, and the rumours themselves tend to come from North Americans where that kind of thing may be a bit more common. I'm open to correction on this if anyone has stats for the situation in Ireland but from my experience docs are highly attentive about all prescriptions here nearly all of the time.

Sorry I meant to reply to this earlier but had a mad week. Taco chips I personally think GPs are at fault over the doling out of antibiotics not hospital clinicians.

gctest50

steddyeddy wrote: »

..........Taco chips I personally think GPs are at fault over the doling out of antibiotics............

their customers/patients are at fault

if they don't dole them out - some/most*** will just "get a few" from their mate that had some left over

then they will harp on "that GP is no good" (ie didn't horse out what they wanted)




***(they of that belief that there is a tablet for anything and everything )

steddyeddy

gctest50 wrote: »

their customers/patients are at fault

if they don't dole them out - some/most*** will just "get a few" from their mate that had some left over

then they will harp on "that GP is no good" (ie didn't horse out what they wanted)




***(they of that belief that there is a tablet for anything and everything )

I realise that A GP's patients often puts them under pressure but at the end of the day they're professionals and shouldn't be compromising the health of the nation because of pressure placed on them.

gctest50

steddyeddy wrote: »

I realise that A GP's patients often puts them under pressure but at the end of the day they're professionals and shouldn't be compromising the health of the nation because of pressure placed on them.

It's very hard to win with crazy though

any ideas on how to beat it though ?

more placebos packaged up as "the real deal" ?

disulfiram or something in almost every tablet ? ( package them all as "NEW !!!! IMPROVED !!!")

steddyeddy

gctest50 wrote: »

It's very hard to win with crazy though

any ideas on how to beat it though ?

more placebos packaged up as "the real deal" ?

disulfiram or something in almost every tablet ? ( package them all as "NEW !!!! IMPROVED !!!")

My friend's a GP and it sounds like he has to deal with loons TBH. I have a lot of sympathy for the GPs in this regard. I don't think calling the patients customers helps TBH.

El_Dangeroso

If a patient comes in putting pressure on a GP to prescribe 'something' then it's 100% the GP's responsibility to not prescribe 'something' that is leading us into an antibiotic-less future.

It's a total waste of money to have these public awareness campaigns when all that needs to be done is to not prescribe incorrectly.

If I wanted liquid morphine how much 'pressure' would I need to apply to get it?

_Tombstone_

Agricultural use is the major problem in relation to resistance. Constant low dose use of the last resort of Antibiotics, because of cramped conditions or to speed up weight gain. 80% of all use by some estimates, massive.

FDA has given "guidance" to stop. :pac::pac::pac: LOL, it's depressing me the way Industry runs everything these days.

Doctors aren't blameless, vast majority of them around my way pawn off patients/customers with an Antibiotic....to justify the fee I guess....but when people are dumb enough to go in with a runny nose then why not.

My sister has over a Dozen of AntiB Courses gone into her young fella in the last few years, a sneeze and she's popping them into him. Fupping Disgrace.

So of the 20% left over from above, over half of that is wasted aswell.

But the running out of an Antibiotic should never have been a thing anyway, I see they've finally got off their backsides and "found" a new one that "may" be unresistable, though it's gram positive or negative only, I forget which.

http://news.sciencemag.org/biology/2015/01/microbe-found-grassy-field-contains-powerful-antibiotic

http://consumerist.com/2014/09/18/white-house-acknowledges-over-use-of-antibiotics-in-farm-animals-shrugs/

Links^^.

steddyeddy

_Tombstone_ wrote: »

Agricultural use is the major problem in relation to resistance. Constant low dose use of the last resort of Antibiotics, because of cramped conditions or to speed up weight gain. 80% of all use by some estimates, massive.

FDA has given "guidance" to stop. :pac::pac::pac: LOL, it's depressing me the way Industry runs everything these days.

Doctors aren't blameless, vast majority of them around my way pawn off patients/customers with an Antibiotic....to justify the fee I guess....but when people are dumb enough to go in with a runny nose then why not.

My sister has over a Dozen of AntiB Courses gone into her young fella in the last few years, a sneeze and she's popping them into him. Fupping Disgrace.

So of the 20% left over from above, over half of that is wasted aswell.

But the running out of an Antibiotic should never have been a thing anyway, I see they've finally got off their backsides and "found" a new one that "may" be unresistable, though it's gram positive or negative only, I forget which.

http://news.sciencemag.org/biology/2015/01/microbe-found-grassy-field-contains-powerful-antibiotic

http://consumerist.com/2014/09/18/white-house-acknowledges-over-use-of-antibiotics-in-farm-animals-shrugs/

Links^^.

Running out of antibiotics is very much a thing. The newly discovered antibiotic was followed by several decades of no new antibiotics being discovered.

_Tombstone_

steddyeddy wrote: »

Running out of antibiotics is very much a thing. The newly discovered antibiotic was followed by several decades of no new antibiotics being discovered.

Was anyone actually looking?

steddyeddy

_Tombstone_ wrote: »

Was anyone actually looking?

Yes there were thousands of scientists looking. It got so bad that many people involved in antibiotic discovery couldn't get funding because they weren't getting results. Someone is always looking.

his_dudeness

_Tombstone_ wrote: »

Was anyone actually looking?

Anecdotally, there is not as much antibiotic research ongoing, as ultimately they will only be taken for a short period of time, until the infection clears, therefore not providing the best return on the pharmaceutical companies investment. Part of the reason that most pharma research is directed towards chronic disease and cancer management

_Tombstone_

steddyeddy wrote: »

Yes there were thousands of scientists looking. It got so bad that many people involved in antibiotic discovery couldn't get funding because they weren't getting results. Someone is always looking.

Nope, I don't think so.

his_dudeness wrote: »

Anecdotally, there is not as much antibiotic research ongoing, as ultimately they will only be taken for a short period of time, until the infection clears, therefore not providing the best return on the pharmaceutical companies investment. Part of the reason that most pharma research is directed towards chronic disease and cancer management

Yea this^^, I checked after last night and it's only been like 1% of total available private and public money going into Antibiotic Research for many many years.

Big Companies like Pfizer pulled out years ago cuz they couldn't get longer patents or get away with charging €000,000 for a treatment like they do with some/most of the new drugs that only treat symptoms/or keep you alive for a few weeks longer like they do now.


24,000 dying a year (i think) in the US alone because of AntiB Resistant and it's all down to greed/money.


And look, here's another new one found in a mushroom that grows from horse poo, how many new ones is that in like 6 months.

steddyeddy

_Tombstone_ wrote: »

Nope, I don't think so.

Yea this^^, I checked after last night and it's only been like 1% of total available private and public money going into Antibiotic Research for many many years.

Big Companies like Pfizer pulled out years ago cuz they couldn't get longer patents or get away with charging €000,000 for a treatment like they do with some/most of the new drugs that only treat symptoms/or keep you alive for a few weeks longer like they do now.


24,000 dying a year (i think) in the US alone because of AntiB Resistant and it's all down to greed/money.


And look, here's another new one found in a mushroom that grows from horse poo, how many new ones is that in like 6 months.

Right another big pharma are out to get us rhetoric is it?

L1011

_Tombstone_ wrote: »

Nope, I don't think so.

You think wrong.

There's a good chance that both the "discoveries" you refer to aren't going to pass full trials, remember. Plenty of new discoveries go nowhere because they don't live up to their promise. Nobody has discovered something they can have packaged in pharmacies in 6 months.

steddyeddy

The idea that scientists ignored antibiotics for decades is laughable.

_Tombstone_

steddyeddy wrote: »

Right another big pharma are out to get us rhetoric is it?

Hmm, OK.

L1011 wrote: »

You think wrong.

There's a good chance that both the "discoveries" you refer to aren't going to pass full trials, remember. Plenty of new discoveries go nowhere because they don't live up to their promise. Nobody has discovered something they can have packaged in pharmacies in 6 months.

Yea, no harm with a delay with the abuse and....a deliberately broken system that's been let carry on for decades for the gain of a small number.

Resistance was first spotted in the 70s and nothing or very little was done.


Anyway, 40-42 new AntiBiotics being worked on at the min that I can see, 80% failure rate due to efficacy or it's safety, so around 8-10 new ones by 2020.

steddyeddy

_Tombstone_ wrote: »

Hmm, OK.

Yea, no harm with a delay with the abuse and....a deliberately broken system that's been let carry on for decades for the gain of a small number.

Resistance was first spotted in the 70s and nothing or very little was done.


Anyway, 40-42 new AntiBiotics being worked on at the min that I can see, 80% failure rate due to efficacy or it's safety, so around 8-10 new ones by 2020.

How are there 40-42 antibiotics being worked on when you previously said they aren't being worked on?

_Tombstone_

steddyeddy wrote: »

The idea that scientists ignored antibiotics for decades is laughable.

Spellberg et al argued that the decline in antibacterial research and development is at least one decade old,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095020/

steddyeddy wrote: »

How are there 40-42 antibiotics being worked on when you previously said they aren't being worked on?

Quote where I said that.

They weren't working on them, they are now.

Simon2015

My GP tried to get me to take antidepressants even though I wasnt depressed.

_Tombstone_

steddyeddy wrote: »

The idea that scientists ignored antibiotics for decades is laughable.

Are you still laughing??

steddyeddy

_Tombstone_ wrote: »

Are you still laughing??

No because I personally know researchers who have been involved in researching antibiotics and looking for ways around antibiotic resistance since the eighties.