Furious Seasons

August 21, 2009

Study: 50 Percent Of Docs Don't Know Indications Drugs Are Approved For

A new study is out in Pharmacoepidemiology and Drug Safety and it asserts that about 50 percent of the time doctors don't know the approval status of certain drugs and, apparently, think they are approved for indications for which they are not. Maybe that's how the crisis in off-label prescribing came about, likely aided and abetted by pharma reps.

"Psychiatrists and primary care physicians were given lists of drug-indication pairs that differed except for six pairs: valproic acid for bipolar disorder, mania; escitalopram (Lexapro) for panic disorder; gabapentin for diabetic neuropathy; trazodone for insomnia; venlafaxine (Effexor) for adjustment disorder; and quetiapine (Seroquel) for dementia with agitation.
"The authors received 457 usable surveys, 54% from psychiatrists and 46% from primary care physicians. On average, primary care physicians had prescribed 10 of the drugs at least once in the previous year for any indication, and psychiatrists had prescribed 11.

"Respondents knew the correct FDA-approval status of 55% (mean) to 57% (median) of the drug-indication pairs.

"When the pairs were limited to drugs the respondents had prescribed in the past year, the mean accuracy increased to 60% and the median to 63%.

"Overall, psychiatrists demonstrated better knowledge of FDA approval status (66% mean, 71% median) than did primary care physicians (42% mean, 38% median)."

I know doctors need to keep a lot of information in their heads about drugs, but this kind of failure rate is absurd and should give anyone pause who get a scrip from a doc.

Posted by Philip Dawdy at August 21, 2009 11:38 AM

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Comments

Hmm. Perhaps this explains why my last shrink was so insistent that Seroquel was all I needed to get over my depression. Maybe he was under the impression it was approved for this purpose.

Posted by: Francesca Allan at August 21, 2009 01:02 PM

I see more and more doctors querying databases from their smartphones to determine drug facts and indications, even in my rural area. Goodness only knows what other databases they have access to.

I have little use for the medical profession in general and one day I think we will be able to replace a great many doctors by elegantly scripted queries and decision trees, which will be a very, very good thing.

Posted by: Marlboro at August 21, 2009 08:27 PM

It's interesting to see some drug-indication pairs mentioned where the most effective treatment isn't pharmacological at all, eg. adjustment disorder and to a lesser degree insomnia.

Posted by: Astrid at August 22, 2009 04:51 AM

Astrid - I agree. The evidence for non-pharmaceutical treatmetns for insomnia is far more defensible that your note suggests -- it is a slam dunk. Plus, none of the negative side effects. I have a couple posts on insomnia treatment at my blog, medsvstherapy.com.

The evidence exists that decent psychotherapy is at least equivalent to medications, and has positive, not negative, side effects.

I believe that the evidence is out there, in everyday practice, that physicians, including psychiatrists, simply are not aware, or simply are not convinced. I believe the big diff is that the pharma reps come by regularly, and that nearly all of physican "continuing medical education" CME, of which docs must get many hours per year to renew license, is developed and provided by Big Pharma.

That would be a great test: Considering efficacy and side effects, for which DSM disorders is psychotherapy preferred over pharmacotherapy?

Posted by: MedsVsTherapy at August 24, 2009 06:07 AM