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David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH
Harvard Medical School Cambridge, Mass

JAMA. 1995;273(6):457-458.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—Like some correspondents, we have prescribed from our list of contraindicated drugs, sometimes appropriately. Why refuse a dying patient's request for propoxyphene? But in reviewing our own charts we found far more instances of ill-considered prescribing of inappropriate drugs.

Discussions with full-time practitioner colleagues at our department meetings assured us that our deficiencies were not unique. Subsequently, in our hospital, use of the contraindicated drugs in elderly inpatients fell by two thirds without regulatory intervention. Perhaps this collegial interchange was more successful than our article in conveying our goal of improving care, not blaming physicians.

We are troubled by the defensive tone of some letters. There is a raft of evidence that physicians often prescribe poorly. Our article surely understates the frequency; we didn't assess good drugs used for bad indications, at excessive doses, for too long, or with interacting agents. If JAMA isn't an appropriate forum to . . . [Full Text PDF of this Article]

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