Pharmaceutical Use

Adverse Drug Reaction Deaths Exaggerated

A widely reported article in the April 15, 1998, Journal of American Medical Association (JAMA) said that adverse drug reactions (ADRs) in U.S. hospitals may be responsible for more than 100,000 deaths nationwide each year, making it one of the leading causes of death. However, experts question whether there is an epidemic of ADR deaths -- or simply an exaggeration of a problem.

The JAMA study, a meta-analysis of 39 previous studies since 1964, estimated that in 1994 2.2 million of 33 million U.S. hospital patients had suffered serious ADRs, of which 106,000 were fatal. That would mean one of every 300 hospital patients dies from an ADR.

  • There are 9,000 prescription drugs on the market today, compared to about 300 in 1965, increasing the chances doctors will make mistakes.

  • While the National Center for Health Statistics (NCHS) reports only about 200 drug reaction deaths per year, it admits that number is probably too low.

  • However, the NCHS reports that in 1995, among 17,558 patients who suffered ADRs and later died in the hospital, 80 percent were 65 or older -- suggesting a high percentage were hospitalized with grave systemic illnesses like cancer.

  • And a 1997 JAMA study found that at a teaching hospital, patients whose deaths were attributed to ADRs were taking an average of 18 different drugs at the time of death.

While the number of ADR deaths is probably underreported, observers point out that saying deaths are linked to drug reactions is not the same as saying they are caused by those drugs. Furthermore, the 39 studies analyzed employed a variety of methods, and concerned patient populations and hospitals that may not be representative, making it difficult to extrapolate the results to all patients.

Source: Arthur Allen, "Overreaction?" New Republic, June 8, 1998.

For JAMA abstract

Health Care Providers Spending More On Drugs

Health care providers are spending more on drugs these days. Observers say the increase in expenditures is due to an aging population, direct consumer advertising of prescription products, faster approval of drugs by the Food and Drug Administration and a willingness to substitute pharmaceuticals for other therapies.

  • In 1996, the average pharmacy cost increase of publicly traded Health Maintenance Organizations (HMOs) was 15 percent to 16 percent, compared with 8 percent for 1995 and 7 percent for 1994.

  • Employers' per capita outlays for employee drug benefits increased 17.5 percent in 1997, to $430.

  • And pharmaceutical companies saw profits jump 15 percent to 20 percent in 1997.

HMOs cover 70 percent of enrollees' prescription drug bills and provide significantly larger discounts for prescriptions because they believe drug treatment can avoid more costly hospitalizations.

However, HMOs and pharmacy benefits companies have begun to stem their cost increases by limiting drug formularies -- the specific drugs or generic equivalents they will pay for -- with 90 percent of HMOs intending to adopt a partially closed formulary in 1998.

Source: H. Meyer, "The Pills That Ate Your Profits," Hospitals & Health Networks, February 5, 1998.

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