Anti-inflammatory drugs overprescribed.

Ten years after a physician committee warned in medical journals against overprescribing anti-inflammatory drugs, a Canadian study finds the drugs still widely ordered and, in nearly 42 percent of the cases studied, unnecessary. Moreover, overprescribing was linked to shorter visits to the doctor's office, researchers at McGill University in Montreal report in the Sept. 15 Annals of Internal Medicine.

Nonsteroidal anti-inflammatory drugs such as naproxen and diclofenac boost the risk of gastrointestinal bleeding and perforation of the stomach lining. They cause roughly 80,000 hospitalizations and nearly 8,000 deaths in the United States and Canada annually. Elderly people account for most of the deaths linked to these drugs. Still, 100 million prescriptions for these drugs are ordered yearly in Canada, the United States, and Great Britain combined.

To assess how widely the drugs are prescribed to elderly patients, a panel of doctors reviewed the diagnoses of 112 Canadian physicians. These practitioners were recruited for the survey, but they didn't know what aspect of their practice would be monitored. In fact, eight people age 67 were trained to be patients. During office visits, they related a specified set of symptoms, gave some medical history, and answered questions. Later, they recorded the length of the visit and the doctor's action. They completed 276 visits undetected.

In 139 of these visits--ostensibly for a flare-up of chronic hip pain--the correct treatment would have been acetaminophen but no anti-inflammatory drugs. However, nonsteroidal anti-inflammatories were prescribed 52 times, and anti-inflammatory steroids were ordered in a few cases. Unneeded drugs were more common when doctors failed to elicit personal histories, which included high blood pressure or ulcers, conditions that make people poor candidates for anti-inflammatories. Such questions lengthened visits by 9 minutes, on average.

The pseudopatients also made 137 visits for gastric distress caused by anti-inflammatories. Most doctors correctly ordered the drugs stopped or scaled back and prescribed anti-ulcer drugs. Again, many failed to take full histories.

In an accompanying commentary, Frank Davidoff, a physician and editor of the journal, calls the connection between shorter office visits and inappropriate prescribing "particularly disturbing." In a 1995 survey, 41 percent of U.S. doctors reported that the time they spent with patients had decreased, on average, over the past 3 years, he notes.