r.i.c.e.

I just read a brand-new and very interesting paper by Janet Currie, Wanchuan Lin and Wei Zhang, entitled, “Patient Knowledge and Antibiotic Abuse: Evidence from an Audit Study in China.” The authors find that antibiotics are very often prescribed when unnecessary, and suggest that doctor’s incentives to prescribe expensive antibiotics (they get kickbacks from drug companies for prescribing their medications!) could have something to do with it.

Although we know that antibiotics are being overprescribed, and taken improperly around the world, we don’t know so much about why it is happening and how it can be prevented. Das and Hammer (2004) observe patient provider interactions in public and private facilities in Delhi and find similarly high levels of inappropriate prescription of antibiotics. They find that part of the problem of over-use of antibiotics is a competence problem; may doctors do not know when antibiotics are inappropriate. They also find that private providers prescribe more antibiotics than public providers for the same conditions, suggesting that patients expect antibiotics (private doctors depend on patient flow to make money, public doctors are paid the same salary no matter how many patients they see). As in China, there is often also a direct financial incentive to overprescribe antibiotics—sometimes the “private doctors” are also purveyors of medicines.

Interesting, both of the studies suggest that patient knowledge could be an important way to curb over prescription of antibiotics. Currie, Lin and Zhang find that when fake cold patients report having read on the internet that antibiotics should not be given for the common cold, doctors are less likely to prescribe antibiotics (although over 30% of them still do!). Das and Hammer talk about how, if patients were less insistent on receiving antibiotics, doctors would be less likely to prescribe them unnecessarily. Both articles talk about the huge costs to poor consumers of paying out-of-pocket for these unnecessary drugs.

The findings of these papers are really important in an age of increasing antibiotic resistance. More studies like these two should be done to better understand the overuse of antibiotics; others should focus on better understanding the threats posed by antibiotic resistant bacteria and how fast they’re likely to evolve. I know that Dean and Michael Geruso are starting to look at some data from the United States, and I look forward to seeing their results!