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MisprescribingandOverprescribingofDrugs
Sevenalltoooftendeadlysinsofprescribing
EvidenceofMisprescribingandOverprescribing
TheCausesofMisprescribingandOverprescribing
Thenumbersarestaggering:in2003,anestimated3.4billionprescriptionswerefilledinretaildrugstores
andbymailorderintheUnitedStates.Thataveragesoutto11.7prescriptionsfilledforeachofthe290
millionpeopleinthiscountry.1Butmanypeopledonotgetanyprescriptionsfilledinagivenyear,soitis
alsoimportanttofindouthowmanyprescriptionsarefilledbythosewhofilloneormoreprescriptions.In
astudybasedondatafrom2000,morethantwiceasmanyprescriptionswerefilledforthose65and
older(23.5prescriptionsperyear)thanforthoseyoungerthan65(10.1prescriptionsperyear).2Another
wayoflookingatthehighrateofprescriptionsamongolderpeopleisthegovernmentfindingthat
althoughMedicarebeneficiariescompriseonly14%ofthecommunitypopulation,theyaccountformore
than41%ofprescriptionmedicineexpenses.3
Thereisnodisputethatformanypeople,prescriptionsarebeneficial,evenlifesavinginmanyinstances.
Buthundredsofmillionsoftheseprescriptionsarewrong,eitherentirelyunnecessaryorunnecessarily
dangerous.Inappropriateprescribingisanacademicallygentleeuphemismforprescriptionsforwhich
therisksoutweighthebenefits,thusconferringanegativehealthimpactonthepatient.Arecent
comprehensivereviewofstudiesofsuchinappropriateprescribinginolderpatientsfoundthat21.3%of
communitydwellingpatients65yearsorolderwereusingatleastonedruginappropriatelyprescribed.
Muchmoresothanage,perse,thetotalnumberofdrugsbeingprescribedwasanimportantpredictorof
inappropriateprescribing,aswasfemalegender.4Anotherstudyfoundthat,conservativelyusingvery
narrowcriteriaforinappropriateprescribingelderlyUnitedStatespatientswereprescribedatleastone
inappropriatedrugatanestimated16.7millionvisitstophysicianofficesorhospitaloutpatient
departmentsintheyear2000.5Examplesofspecificdrugsthathavebeeninappropriatelyprescribed,
includingstudiesinvolvingyoungeradultsandchildren,aregivenlaterinthissection.
Attheveryleast,misprescribingwastestensofbillionsofdollars,barelyaffordablebymanypeoplewho
payfortheirownprescriptions.Buttherearemuchmoreseriousconsequences.Asdiscussedin
AdverseDrugReactions(../../go.cfm?type=otherpage&id=4),morethan1.5millionpeopleare
hospitalizedandmorethan100,000dieeachyearfromlargelypreventableadversereactionstodrugs
thatshouldnothavebeenprescribedastheywereinthefirstplace.6Whatfollowsisasummaryofthe
sevenalltoooftendeadlysinsofprescribing.
First:Thediseaseforwhichadrugisprescribedisactuallyanadversereactiontoanother
drug,masqueradingasadiseasebutunfortunatelynotrecognizedbydoctorandpatientassuch.
Insteadofloweringthedoseoftheoffendingdrugorreplacingitwithasaferalternative,thephysician
addsaseconddrugtotheregimentotreattheadversedrugreactioncausedbythefirstdrug.
Examplesdiscussedonthiswebsite(seelaterinthissectionandinDrugInducedDiseases
(../../go.cfm?type=otherpage&id=5))includedruginducedparkinsonism,depression,sexualdysfunction,
insomnia,psychoses,constipation,andmanyotherproblems.
Second:Adrugisusedtotreataproblemthat,althoughinsomecasessusceptibletoa
pharmaceuticalsolution,shouldfirstbetreatedwithcommonsenselifestylechanges.Problems
suchasinsomniaandabdominalpainoftenhavecausesthatrespondverywelltonondrugtreatment,
andoftenthephysiciancanuncoverthesecausesbytakingacarefulhistory.Otherexamplesinclude
medicalproblemssuchashighbloodpressure,mildadultonsetdiabetes,obesity,anxiety,and
situationaldepression.Doctorsshouldrecommendlifestylechangesasthefirstapproachforthese
conditions,ratherthanautomaticallyreachfortheprescriptionpad.
Third:Themedicalproblemisbothselflimitedandcompletelyunresponsivetotreatmentssuch
asantibioticsordoesnotmerittreatmentwithcertaindrugs.Thisisseenmostclearlywithviral
infectionssuchascoldsandbronchitisinotherwisehealthychildrenoradults.
Fourth:Adrugisthepreferredtreatmentforthemedicalproblem,butinsteadofthesafest,most
effectiveandoftenleastexpensivetreatment,thephysicianprescribesoneoftheDoNotUse
drugslistedonthiswebsiteoranother,muchlesspreferablealternative.Anexampleofaless
preferablealternativewouldbeadrugtowhichthepatienthasaknownallergythatthephysiciandidnot
askabout.

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Fifth:Twodrugsinteract.Eachonitsownmaybesafeandeffective,buttogethertheycancause
seriousinjuryordeath.
Sixth:Twoormoredrugsinthesametherapeuticcategoryareused,theadditionalone(s)not
addingtotheeffectivenessofthefirstbutclearlyincreasingtherisktothepatient.Sometimesthe
drugscomeinafixedcombinationpill,sometimesastwodifferentpills.Oftenheartdrugsormind
affectingdrugsareprescribedinthismanner.
Seventh:Therightdrugisprescribed,butthedoseisdangerouslyhigh.Thisproblemisseen
mostofteninolderadults,whocannotmetabolizeorexcretedrugsasrapidlyasyoungerpeople.This
problemisalsoseeninsmallpeoplewhoareusuallyprescribedthesamedoseasthatprescribedto
peopleweighingtwotothreetimesasmuchastheydo.Thus,perpound,theyaregettingtwotothree
timesasmuchmedicineasthelargerperson.
EvidenceofMisprescribingandOverprescribing
Herearesomeexamplesfromrecentstudiesbyagrowingnumberofmedicalresearchersdocumenting
misprescribingandoverprescribingofspecifictypesofdrugs:
TreatingAdverseDrugReactionswithMoreDrugs
ResearchersattheUniversityofTorontoandatHarvardhaveclearlydocumentedandarticulatedwhat
theycalltheprescribingcascade.Itbeginswhenanadversedrugreactionismisinterpretedasanew
medicalcondition.Anotherdrugisthenprescribed,andthepatientisplacedatriskofdeveloping
additionaladverseeffectsrelatingtothispotentiallyunnecessarytreatment.7Topreventthisprescribing
cascade,doctorsandpatientsshouldfollowwhatwecallRule7oftheTenRulesforSaferDrugUse
(seeProtectingYourselfandYourFamilyfromPreventableDruginducedInjury(../../go.cfm?
type=otherpage&id=45)):Assumethatanynewsymptomyoudevelopafterstartinganewdrugmightbe
causedbythedrug.Ifyouhaveanewsymptom,reportittoyourdoctor.
Someoftheinstancesoftheprescribingcascadethattheseandotherresearchershavedocumented
include:
TheincreaseduseofantiParkinsonsdrugstotreatdruginducedparkinsonismcausedbythe
heartburndrugmetoclopramide7(REGLAN)orbysomeoftheolderantipsychoticdrugs.
Asharplyincreaseduseoflaxativesinpeoplewithdecreasedbowelactivitythathasbeencausedby
antihistaminessuchasdiphenhydramine(BENADRYL),antidepressantssuchasamitriptyline(ELAVIL)
aDoNotUsedrugorsomeantipsychoticdrugssuchasthioridazine(MELLARIL).8
Anincreaseduseofantihypertensivedrugsinpeoplewithhighbloodpressurethatwascausedor
increasedbyveryhighdosesofnonsteroidalantiinflammatorydrugs(NSAIDs),usedaspainkillersor
forarthritis.9
FailingtoTreatCertainProblemswithNondrugTreatments
Researchhasshownthatmanydoctorsaretooquicktopulltheprescriptiontrigger.Inonestudy,in
whichdoctorsandnursepractitionerswerepresentedwithpartofaclinicalscenarioaswouldoccur
whenfirstseeingapatientwithamedicalproblemandthenencouragedtoasktofindoutmoreabout
thesourceoftheproblem,65%ofdoctorsrecommendedthatapatientcomplainingofinsomniabe
treatedwithsleepingpillseventhough,hadtheyaskedmorequestionsaboutthepatient,theywould
havefoundthatthepatientwasnotexercising,wasdrinkingcoffeeintheevening,and,although
awakeningat4a.m.,wasactuallygettingsevenhoursofsleepbythen.10
Inasimilarstudy,doctorswerepresentedwithapatientwhocomplainedofabdominalpainandwhose
endoscopyshoweddiffuseirritationinthestomach.Sixtyfivepercentofthedoctorsrecommended
treatingtheproblemwithadrugahistamineantagonist(suchasZantac,Pepcid,orTagamet).Had
theyaskedmorequestionstheywouldhavediscoveredthatthepatientwasusingaspirin,drinkingalot
ofcoffee,smokingcigarettes,andwasunderconsiderableemotionalstressallpotentialcontributing
factorstoabdominalpainandstomachirritation.
Insummarizingtheoriginofthisoverprescribingproblem,theauthorsstated:Apparentlyquiteearlyin
theformulationoftheproblem,theconceptualfocus[ofthedoctor]appearstoshiftfrombroader
questionslikeWhatiswrongwiththispatient?orWhatcanIdotohelp?tothemuchnarrowerconcern,
WhichprescriptionshallIwrite?Theyarguedthatthisapproachwassupportedbythebarrageof
promotionalmaterialsthatonlyaddressdrugtreatment,notthemoresensiblelifestylechangesto
preventtheproblem.11
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Inbothoftheabovescenarios,nursepractitionersweremuchmorelikelythandoctorstotakean
adequatehistorythatelicitedthecausesoftheproblemsand,notsurprisingly,wereonlyonethirdas
likelyasthedoctorstodecideonaprescriptionastheremedyinsteadofsuggestingchangesinthe
patientshabits.
Throughoutthiswebsite,inthediscussionsaboutinsomnia,highbloodpressure,situationaldepression,
mildadultonsetdiabetes,andotherproblems,youwillfindoutabouttheproveneffectivenondrug
remediesthatshouldfirstbepursuedbeforeyieldingtotheriskierpharmaceuticalsolutions.
TreatingViralInfectionswithAntibioticsorTreatingOtherDiseaseswithDrugsThatAreNotEffective
forThoseProblems
Tworecentlypublishedstudies,basedonnationwidedatafromofficevisitsforchildrenandadults,have
decisivelydocumentedtheexpensiveanddangerousmassiveoverprescribingofantibioticsfor
conditionsthat,becauseoftheirviralorigin,donotrespondtothesedrugs.Fortyfourpercentofchildren
under18yearsoldweregivenantibioticsfortreatmentofacoldand75%fortreatmentofbronchitis.
Similarly,51%ofpeople18orolderweretreatedwithantibioticsforcoldsand66%forbronchitis.
Despitethelackofevidenceofanybenefitformostpeoplefromthesetreatments,morethan23million
prescriptionsayearwerewrittenforcolds,bronchitis,andupperrespiratoryinfections.Thisaccounted
forapproximatelyonefifthofallprescriptionsforantibioticswrittenforchildrenoradults.12,13An
accompanyingeditorialwarnedofincreasedcostsfromunnecessaryprescriptions,adversedrug
reactions,and[subsequent]treatmentfailuresinpatientswithantibioticresistantinfectionsasthe
reasonstotrytoreducethisepidemicofunnecessaryantibioticprescribing.14
Similarmisprescribingofadrugusefulandimportantforcertainproblems,butnotnecessaryor
effective,andoftendangerous,forotherproblemscanbeseeninanotherrecentstudy.Inthiscase,
47%ofthepeopleadmittedtoanursinghomewhoweretakingdigoxin,animportantdrugfortreatingan
abnormalheartrhythmcalledatrialfibrillationorfortreatingseverecongestiveheartfailure,didnothave
eitherofthesemedicalproblemsandweretherebybeingputatriskforlifethreateningdigitalistoxicity
withoutthepossibilityofanybenefit.15
Afinalexampleinthiscategoryinvolvestheoveruseofacertainofdrugs,inthiscasecalciumchannel
blockers,whichhavenotbeenestablishedaseffectivefortreatingpeoplewhohavehadarecentheart
attack.Thestudyshowsthatthisprescribingpatternactuallydidindirectdamagetopatientsbecause
theirusewasreplacingtheuseofbetablockers,drugsshowntobeveryeffectiveforreducingthe
subsequentriskofdeathorhospitalizationfollowingaheartattack.Useofacalciumchannelblocker
insteadofabetablockerwasassociatedwithadoubledriskofdeath,andbetablockerrecipientswere
hospitalized22%lessoftenthannonrecipients.16
TheCausesofMisprescribingandOverprescribing
TheDrugIndustry
Theprimaryculpritinpromotingthemisprescribingandoverprescribingofdrugsisthepharmaceutical
industry,whichnowsellsabout$216billionworthofdrugsintheUnitedStatesalone.1Theindustry
usesloopholesinthelawnotrequiringproofofsuperiorityoverexistingdrugsforapproval,and
otherwiseintimidatestheFoodandDrugAdministration(FDA)intoapprovingrecordnumbersofmetoo
drugs(drugsthatoffernosignificantbenefitoverdrugsalreadyonthemarket)thatoftenhave
dangerousadverseeffects.Inaddition,theindustryspendswellinexcessof$21billionayearto
promotedrugs 17usingadvertisingandpromotionaltricksthatpushatorthroughtheenvelopeofbeing
falseandmisleading.Thisindustryhasbeenextremelysuccessfulindistorting,inaprofitablebut
dangerousway,therationalprocessesforapprovingandprescribingdrugs.Twostudiesofthe
accuracyofadsforprescriptiondrugswidelycirculatedtodoctorsbothconcludedthatasubstantial
proportionoftheseadscontainedinformationthatwasfalseormisleadingandviolatedFDAlawsand
regulationsconcerningadvertising.18,19
Thefastestgrowingsegmentofdrugadvertisingisdirectednotatdoctorsbutatpatients.Ithasbeen
estimatedthatfrom1991to2002DTC(directtoconsumer)advertisingexpendituresintheUnited
Statesgrewfromabout$60millionayearto$3billionayear,17anincreaseof50foldinjusteleven
years,employingmisleadingadvertisingcampaignssimilartothoseusedfordoctors.Astudyby
ConsumerReportsof28suchadsfoundthatonlyhalfwerejudgedtoconveyimportantinformationon
sideeffectsinthemainpromotionaltext,only40%werehonestaboutefficacyandfairlydescribedthe
benefitsandrisksinthemaintext,and39%oftheadswereconsideredmoreharmfulthanhelpfulby
atleastonereviewer.20Thiscampaignhasbeenextremelysuccessful.Accordingtoadrugindustry
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spokesman,Theresastrongcorrelationbetweentheamountofmoneypharmaceuticalcompanies
spendonDTCadvertisingandwhatdrugspatientsaremostoftenrequestingfromphysicians.The
advertisingisdefinitelydrivingpatientstothedoctorsoffice,andinmanycases,leadingpatientsto
requestthedrugsbyname.21TheproblemswithDTCadvertisingarebestsummedupinanarticle
writtenbyaphysicianmorethan15yearsagointheNewEnglandJournalofMedicine,beforethe
currentbingehadreallybegun:Ifdirect[toconsumer]advertisingshouldprevail,theuseofprescription
medicationwouldbewarpedbymisleadingcommercialsandhucksterism.Thechoiceofapatients
medication,evenofhisorherphysician,couldthencometodependmoreontheattractivenessofafull
pagespreadorprimetimecommercialthanonmedicalmerit...suchadvertisingwouldserveonlythead
makersandthemedia,andmightwellharmourpatients.22
TheFoodandDrugAdministration(FDA)
AttemptingtofendoffFDAweakeninglegislationevenworsethanthatwhichwassignedintolawin
1997,theFDAhasbentoverbackwardstoapprovemoredrugs,culminatingin1996and1997whenthe
agencyapprovedalargernumberthanhadeverbeenapprovedinanytwoyearperiod.Thousandsof
peoplewereinjuredorkilledaftertakingoneofthreesuchrecentlyapproveddrugs(whichhave
subsequentlybeenrecalledfromthemarket).Thesedrugsweretheweightlossdrugdexfenfluramine
(REDUX),theheartdrugmibefradil(POSICOR),andthepainkillerbromfenac(DURACT).Otherdrugs
thatwouldnothavegottenapprovedinamorecautiouseraattheFDAhavealsobeenapproved,but
arelikelyeithertobebannedortobeforcedtocarryseverewarningsthatwillsubstantiallyreducetheir
use.ManyoftheseareincludedonthiswebsiteandlistedasDoNotUsedrugs.
Inthemorethan30yearssincethePublicCitizensHealthResearchGroupstartedmonitoringtheFDA
andthedrugindustry,thecurrentproindustryattitudeattheFDAisasbadanddangerousasithas
everbeen.Inadditiontorecordnumbersofapprovalsofquestionabledrugs,FDAenforcementover
advertisinghasallbutdisappeared.Fromapeaknumberof157enforcementactionstostopillegal
prescriptiondrugadsthatunderstaterisksand/oroverstatebenefitsin1998,thenumberhasdecreased
toonly24an85%decreasein2003.23Thereisnoevidencethattheaccuracyorlegalityofthese
adshasincreasedduringthisinterval,andtheamountofsuchadvertisinghasclearlyincreased.The
divisionatFDAresponsibleforpolicingprescriptiondrugadvertisinghasneverbeengivenadequate
resourcestokeepupwiththetorrentofnewlyapproveddrugs.Morerecently,however,ithasalsobeen
thwartedbymarchingordersfromhigherupintheagencyto,effectively,goeasyonprescriptiondrug
advertising.Asaresult,thedrugindustrycorrectlybelievesitcangetawaywithmoreviolative
advertisingthaninthepast.TheroleoftheUnitedStatesCongressinpushingtheFDAintoapproving
moredrugs,andpassing,withtheFDAsreluctantapproval,legislationtofurtherweakentheFDAs
abilitytoprotectthepublic,cannotbeoverlooked.
Physicians
Thewellfinancedpromotionalcampaignsbydrugcompanieswouldnothaveasmuchofanimpactas
theydoweretherenotsuchaneducationalvacuumaboutproperprescribingofdrugs,aserious
problemthatmustbelaidatthefeetofmedicalschoolandresidencytraining.Thevarietiesof
overprescribingandmisprescribingofdrugsbydoctorsthesevenalltoooftendeadlysinsof
prescribingreferredtoaboveareallstronglyenhancedbythemindalteringpropertiesofdrug
promotion.Thebestdoctors,ofwhomtherearemany,donotwastetheirtimetalkingtodrugsales
people,tosspromotionalmaterialsaway,andignoredrugadsinmedicaljournals.Toomanyother
doctors,however,areheavilyinfluencedbydrugcompanies,acceptingfreemeals,freedrinks,andfree
medicalbooksinexchangeforlettingthedrugcompanieseducatethematsymposiainwhichthe
virtuesofcertaindrugsareextolled.Unfortunately,manyofthesedoctorsaretooarroganttorealizethat
thereisnosuchthingasafreelunch.Themajorityofdoctorsattendingsuchfunctionshavebeenfound
toincreasetheirprescriptionsforthetargeteddrugsfollowingattendanceattheteachin.24
Beyondtraditionaladvertisingandpromotionandtheirinfluence,biasofdrugcompanysponsored
research,aspublishedinmedicaljournals,alsocanswaydoctorstowardmorefavorableimpressions
aboutdrugs.Ananalysiswasdoneof56trialsthatwerepaidforbydrugcompaniesandreportedin52
medicaljournalsaboutdrugsforarthritisandpainNSAIDs.(Thesedrugcompanysponsoredstudies
represented85%ofthosethattheresearchersoriginallylookedat.)Instudiesidentifyingthecompanys
drugaslesstoxicthananotherdrug,inbarelyonehalfofthestudieswastherejustificationforthe
findingoflesstoxicity.Thiscertainlyexplainswhy,contrarytofact,newerarthritisdrugsalmostalways
seemsaferthanolder,usuallymuchlessexpensiveones.25

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Afinalexampledemonstratestheignoranceofmanyphysicians,especiallyindealingwithprescribing
drugstoolderadults.AstudyofphysicianswhotreatMedicarepatientsfoundthat70%ofthedoctors
whotookanexaminationconcerningtheirknowledgeofprescribingforolderadultsfailedtopassthe
test.Themajorityofphysicianswhowerecontactedforparticipationinthestudyrefusedtotakethe
test,oftengivingastheirreasonthattheyhadalackofinterestinthesubject.Theauthorsconcluded
manyofthesephysicians[whofailedtheexam]had...notmadegooduseofthebestinformationon
prescribingfortheelderly.26
Pharmacists
Asmallfractionofpharmacistshave,inourview,betrayedtheirprofessionalethicsandareworkingfor
drugcompanies,engaginginsuchactivitiesascallingdoctorstogetthemtoswitchpatientsfromdrugs
madebyacompanyotherthantheonethepharmacistworksfortothepharmacistsemployersdrugs.
Inaddition,pharmacyorganizationssuchastheAmericanPharmaceuticalAssociationandothershave
foughthardtopreventtheFDAfromrequiringaccuratepatientpackageinformationtobedispensedwith
eachprescriptionfilled.
Toomanypharmacists,despitehavingcomputerstoaidthem,havebeenwillingtofillprescriptionsfor
pairsofdrugsthat,becauseoflifethreateningadversedruginteractionsifusedatthesametime,should
neverbedispensedtothesameperson.
Sixteen(32%)of50pharmaciesinWashington,D.C.,filledprescriptionsforerythromycinandthenow
bannedterfenadine(SELDANE)withoutcomment.27Thesetwodrugs,ifusedincombination,cancause
fatalheartarrhythmias.
Inanotherstudy,of245pharmacistsinsevencities,aboutonethirdofpharmacistsdidnotalert
consumerstothepotentiallyfatalandwidelypublicizedinteractionbetweenHismanal,acommonlyused
butnowbannedantihistamine,andNizoral,anoftenprescribedantifungaldrug.Only4outof17
pharmacistswarnedoftheinteractionbetweenoralcontraceptivesandRimactane,anantibioticthat
coulddecreasetheeffectivenessoftheoralcontraceptive.Only3outof61pharmacistsissuedany
verbalwarningsabouttheinteractionbetweenVasotecandDyazidetwodrugsfortreating
hypertensionwhichmayleadtodangerouslyhighlevelsofpotassiumintheblood.28
Inyetanotherstudy,concurrentuseofterfenadine(SELDANE)andcontraindicateddrugsdeclined
overtime.Therateofsamedaydispensingdeclinedby84%,fromanaverageof2.5per100persons
receivingterfenadinein1990to0.4per100personsduringthefirstsixmonthsof1994,whiletherateof
overlappingusedeclinedby57%(from5.4to2.3per100persons).Mostcasesinvolvederythromycin.
Despitesubstantialdeclinesfollowingreportsofseriousdrugdruginteractionsandchangesinproduct
labeling,concurrentuseofterfenadineandcontraindicatedantibioticssuchaserythromycinand
clarithromycin(BIAXIN)andantifungalssuchasketoconazole(NIZORAL)continuedtooccur.29
Patients
Fortoomanypatients,thesystemisstackedagainstyoudrugcompanies,doctors,andpharmacists
aretoooftenmakingdecisionsthatultimatelyderivefromwhatisbestforthedrugcompanies,doctors,
andpharmacists,andnotnecessarilyfromwhatisbestforyou.Thiswebsitehasbeenresearchedand
writtentohelpyoucomeoutaheadinthestrugglewithourhealthcareindustry.
InthesectionsonAdverseDrugReactions(../../go.cfm?type=otherpage&id=4)andDrugInduced
Diseases(../../go.cfm?type=otherpage&id=5),youcanlearnwhichcommonmedicalproblems
depression,insomnia,sexualdisorders,parkinsonism,fallsandhipfractures,constipation,andmany
otherscanactuallybecausedbydrugs.Onceyourecognizetheseproblems,youwillbeenabledto
bettertakecareofyourselfandyourfamily,andbringsuchproblemstoanendbydiscussingsafer
alternativeswithyourphysician.
Onthiswebsite,welistthedrugsweandourconsultantsthinkyoushouldnotuse.Foreachofthese,
werecommendsaferalternatives.Eachdrugprofilelistsdrugcombinationsthatshouldnotbeused
becauseofseriousinteractions.
InProtectingYourselfandYourFamilyfromPreventableDruginducedInjury(../../go.cfm?
type=otherpage&id=45),wepresentadetailedstrategy,beyondinformationonspecificadverseeffects
anddrugs,tohelpyoutousedrugsmoresafely,includingTenRulesforSaferDrugUseandhowtouse
andmaintainyourownDrugWorksheetforPatient,Family,Doctor,andPharmacist.Thisisyour
personalizedplanforavoidingbecomingavictimofoverprescribingormisprescribing.

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Finally,inSavingMoneyWhenBuyingPrescriptionDrugs(../../go.cfm?type=otherpage&id=46),we
discussthelatestinformationaboutgenericdrugsandshowyouhowandwhyyoucanandshouldsave
hundredsofdollarsayearormore.Inshort,thiswebsiteisintendedtohelpyouandyourfamilyto
improveyourhealthbyusingdrugs,ifnecessary,morecarefullyandrecognizingthoseyoushould
avoid.
~~~~~

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StagnittiMN.Trendsinoutpatientprescriptiondrugutilizationandexpenditures,19972000:AHRQStatistical
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17
ThisestimateisfromPhRMA,theprescriptiondrugindustry'sU.S.tradeassociation,andisbasedondatafrom
2002.Availableat:http://www.phrma.org/publications/publications/20031007.892.pdf

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