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Monday, July 1, 2013 12:00 am

A little knowledge….No 3 in a series

 Bill Gardner, posting on The Incidental Economist, Aaron Carroll’s invaluable health care blog, reported the other day on trends in the prescription of  Prilosec, Prevacid and other proton pump inhibitors. These drugs are used to treat gastroesophageal reflux disease or GERD, and their prescription for use by infants has exploded. The patients are babies who spit up and cry a lot and are hard to soothe but who ar not diagnosed with GERD, even though randomized trials have shown that the drugs that work on acid reflux in adults have no effect on babies.

It's unlikely that there are more kids with sour stomachs out there. The condition is diagnosed in some hospitals as much as 13 times the national average. That could be a quality control problem, although it seems more likely to be that people are getting paid to push the pills.

Of course, an MD can't give a kid anything without the parents' okay. The cure for overprescription therefore ought to be simply to explain to parents that these drugs are known not to work? Isn't it? Curious researchers gave parents in a general pediatric clinic a hypothetical clinical scenario. Some were told that their kid had GERD, some not; some were told that the available drugs don't work, some that drugs were available, period.

Parents who'd been told that their kid had GERD and that the available drugs don't work wanted the drugs anyway. Concluded the researchers, These findings suggest that use of disease labels may promote overtreatment by causing people to believe that ineffective medications are both useful and necessary.” But why do disease labels cause people to believe that? I gave myself a headache (effective drugs for which are available) trying to imagine how it happened that so many of us see a difference between being sick – something you get over--– and having a disease – something you treat.  As with so many aspects of health care, the conversation must start with, Patient, heal thyself.

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