September 21, 2018 | ° F

Free antibiotics hurt patients

If you have been near a pharmacy at your local supermarket lately, then chances are that you have heard about the newest advertising tool for these stores: Free antibiotics. The concept is simple enough. The pharmacy absorbs a small financial loss on the antibiotics, but more than makes up for this loss through your other purchases around the store. In the process, it may also convince you to transfer your prescriptions over from its competitors. On the surface, this quid pro quo appears to be a win-win situation that gives patients more access to medications while bolstering store sales. While this strategy does make certain drugs more affordable, it also has great potential to hurt patients.

First of all, free antibiotics — or in a more general sense, free anything — promotes moral hazard and overuse, leading to resistance and unnecessary side effects. Imagine that you just got a sore throat and mild fever. What would you normally do? I think a fair assumption would be to get a bit of extra rest and rely on your own immune system and possibly some over-the-counter medications to relieve the problem. If the symptoms do not seem to get better after a few days, then you might pay a visit to your doctor to get a check-up and prescription.

With the advent of the free antibiotics programs though, you might very well be more inclined to make that doctor's visit earlier and skip the natural defense step altogether. And while this program does not cover all the antibiotics on the market, the inclusion list is quite comprehensive and provides up to a 14-day supply of many of the most commonly prescribed ones — including amoxicillin, cephalexin and Cipro. So chances are that your prescription will be covered.

But by rushing to antibiotics as the first-line solution at the first possible sign of illness, you are subjecting your body to antibiotic resistance, which occurs when the bacteria mutate in ways that makes them more resilient to medications. Antibiotic resistance has become more and more of a public health burden in recent years, aided by its pervasive use in raising livestock as well as its general overuse in society. Staph infections — which were largely treatable with penicillin in the past — are showing increasing resistance against these drugs and newer antibiotics as well. Clinicians today often find themselves depleted of all treatment options due to resistance and can only watch helplessly as their patients wither away. The economic cost of this crisis is currently estimated at $4 billion per year, but no price tag can be attached to its physical and emotional toll. Simply put, we already get enough antibiotics from the meat we eat; there's no need to add to that by freeloading at the local pharmacy.

In addition to causing resistance, antibiotics also cause many side effects, most of them rare, but all of them unworthy of the risk if the drugs are unnecessary. Take amoxicillin for example. Many who have taken this medication have experienced some degree of upset stomach, which is a common side effect of this drug. But a look at its package insert reveals the following non-exhaustive list of additional side effects: Agitation, anemia, anxiety, changes in behavior, colitis, confusion, convulsions, diarrhea, dizziness, hives, hyperactivity, insomnia, liver problems and jaundice, peeling skin, rash and tooth discoloration in children. It should be emphasized that these side effects are quite rare, but the length of this list alone should convince you that these drugs are not without their risks and should be taken prudently.  

Besides promoting over-medication and the associated complications and side effects, free antibiotic programs also lead to significant gaps in health care delivery through the fragmentation of a patient's medication records. Under normal circumstances, patients tend to get all of their prescriptions from a single pharmacy. Not only is this arrangement logistically convenient for the patient, it also allows for optimal care by allowing the pharmacist to ensure that the drugs being prescribed are appropriate given the patient's drug regimen, allergies and other health information.

The extensive didactic and clinical training that all pharmacists go through enables them to detect drug interactions, inappropriate doses and other potential medication errors and work with the patient's physician or nurse to rectify the situation. For example, if a patient is allergic to penicillin, he should not only avoid amoxicillin — an antibiotic in the penicillin class — but possibly also cephalexin and certain other drugs as well.

While pharmacists can contribute significantly to a patient's well-being, this contribution is contingent on the pharmacist having access to a patient's entire medication record, which is not easily accessible between different pharmacy chains. Therefore, if a patient usually gets theophylline — an asthma medication — from the local Rite-Aid and decides to take advantage of ShopRite's free antibiotic program by getting a 14-day supply of erythromycin at the store, neither the pharmacist at Rite-Aid nor his counterpart at ShopRite would be aware of the other drug being taken unless the patient told them this information.

Unfortunately, either due to neglect on the part of the pharmacist to ask or on the part on the patient to tell, this exchange often does not occur, and the interaction that results between these two drugs — which causes an increase in the level of theophylline in the body — can provoke abnormal heart rhythms, seizures, and ultimately, a lengthy and bitter litigation process. Widespread adoption of electronic health records, as mandated by the new health care law, will help to confront this issue through more comprehensive and accessible medication and health records, but we are still many years from reaching that point.

So while these free antibiotic programs popping up in a supermarket near you are laudable in increasing accessibility, the bottom line is that they pose more harm than good to society. Contrary to what is implied by these gimmicks and professed by some economists, health care is not a commodity — getting your prescription is not the same thing as buying, say, a DVD. If you picked up "Pineapple Express" and realized that it did not suit your taste, than the worst that can happen is that you lose a couple of hours of your life and about $20. If you get an antibiotic that was either unnecessary or that interacted with one of your other medications, then you risk life-threatening complications. In medicine, the clinical services and judgments provided by health care professions are as important — if not more so — to optimal patient care as the drug itself, and trying to commoditize healthcare prevents them from being rendered appropriately.  

Bo Wang is an Ernest Mario School of Pharmacy sixth-year student and former president of the Pharmacy Governing Council. His column, "Doctor's Orders," runs on alternate Mondays.

Bo Wang

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