Call on government to address over-prescribing at source – and not just the fallout

CAP views with apprehension the Ministry’s strategy to tackle the fallout created by over-prescription, rather than the underlying cause, by calling on the public to return unused or expired medications at selected government medical centres and hospitals.  The rationale for the move initiated last year is to protect the environment against indiscriminate disposal of expired medications, and save government cost from the reuse of unopened, good condition medications.

According to the Ministry, returned medicines to the Kuala Lumpur Hospital in the first half of the year was valued at RM128,818, while at Seberang Jaya Hospital last year was RM27,899. The most common medications returned were those used to treat cardiovascular diseases, diabetes, anti-hypertensive agents and anti-cholesterol drugs.

Patients often are prescribed medications they don’t need, unwarranted by the symptoms they exhibit, or in greater doses than what is required for their particular ailment. This has become a trend, the norm in government and private hospitals in Malaysia.

From media reports and oft-heard grievances, patients are given a host of medications, pushing up their medical bills per visit. In instances of medical costs being covered by employers, patients usually do not object to the huge bill since they do not fork out from their own pockets. They simply take the medications home, using some while discarding or keeping the rest in storage.

The over-prescribing malaise, both in public or private hospitals, or by the general practitioners, is rampant. We see patients without cough prescribed cough mixtures, those without fever getting paracetamol, and for a mix of lotions or creams thrown in as well.

A simplistic view is to apportion blame on the patients for being ignorant, seeking quick-fix medications, or for accepting piles of medicines along with an inflated price tag, especially if the patients’ costs are covered. The over-prescribing by the medical profession and their relationship with drug companies is however the real issue at hand.

Nobody, most of all the government, should be surprised with the ballooning of healthcare costs over the years and loads of medications unused, left to expire or discarded by patients. It is a huge wastage since quality, fully subsidised medicines dispensed by government hospitals and clinics are literally going down the drain. The Health Ministry spent RM1.6 billion last year on medicines for the 135 hospitals in the country, an increase of almost 15% from the previous year.

A complaint published recently in a newspaper highlighted a man prescribed several different types of medicines every time he visits the Penang General Hospital, thus accumulating a few bags of unused medicines. Another patient a few years ago once lodged a formal complaint against a private hospital in the Klang Valley for prescribing stacks of paracetamol for his slight cough and sore throat, and for being given a high dosage, potent cough mixture and antibiotics in excess, pushing up his medical bill.

Though we owe much to the pharmaceutical industry, we must however object to the current over-prescribing trend that has taken root in society. A host of drugs in a ‘not-to-miss’ approach is not the correct panacea to compensate for the limited time doctors spend in diagnosing ailments. The interest of the patients are being compromised for expediency, convenience, and to facilitate the profit-push of drug companies.

CAP calls for an end to this deep-seated culture of over-prescribing so as to avoid serious health repercussions. The government must review the needless and dangerous prescribing habits of the medical profession:

1. Proper education of the medical profession
This is to get rid of the new and current generation of doctors who find the need to close every consultation with writing prescriptions, no matter how minor the illness. They should endeavour to spend time with the patient, to properly diagnose the sickness, and avoid prescribing too quickly for symptoms not exhibited. They should be trained to look at the patient as a whole, taking a careful history of lifestyle habits, as sometimes what is needed by the patient is rest, exercise, a good sleep, a change in diet, or physical therapy.

2. Break the unhealthy relationship between drug companies and the medical profession
The doctors’ covert support for the pharmaceutical industry is seen in the amount of medications over-prescribed, with doctors being inclined to write down higher dosages than required, and suggesting more expensive medications. The unhealthy influence of the drug companies must be exposed and handled by the authorities if this undue pressure is to be neutralised.

3. Following a proposed list of drugs
The government should work with the medical profession to improve further on the agreed list of drugs allowed in hospital practices to avoid wastage of the taxpayers’ money. For example, the French Agency for Health-Product Security published a list of 77 drugs it has placed under reinforced surveillance – because of undesirable side-effects – to alert the medical profession and society.

4. Avoid the harm from over-prescribing
Besides the side-effects, complications, and addiction from taking medications not needed or in high dosages without any associated benefits, patients may slowly develop resistance to useful drugs, or suffer adverse drug reactions. Deaths may result from preventable adverse reactions to drugs that should not have been prescribed in the first place.

We must kick the habit of over-prescribing for the sake of the health of society and the nation.

Letter to the Editor, 31st August 2011