Such situations result in diagnostic uncertainty, which can either promote antibiotic use if uncertainty leads to prescribing, or impede antibiotic use if uncertainty leads to further observing the course of infection.
Shulman et al. [ 1] detail, for example, how their CPOE system's pull down menu for dosages led to prescribing an injection of 7 mg/kg instead of 7 mg of diamorphine.
LUS led to prescribing a new drug in 19 cases, and to holding a drug previously considered for treatment in 10 cases; moreover, LUS results led to a new procedure (for example, thoracentesis) being performed in six cases, and to a change of the disposition plan in five cases.
"Doctors are led to prescribe drugs that may not be necessarily worth the money, may not be better than a generic that's already on the market and that their patients don't need," Dr. Relman said.
"Pharmaceutical marketing would often lead to physicians prescribing more costly medicines than are necessary," the clinic's medical director, Dr. Al Fisk, said.
That has lead them to prescribe "uppers" to try and head off any more serious symptoms.
The goal is to let the public know about payments that might lead doctors to prescribe treatments that benefit them financially without necessarily benefiting patients.
"Manipulation of medical literature could lead physicians to prescribe drugs that are more costly or may even harm patients," the report said.
Dr. Scott cited several studies that show that the lunches — plus small gifts like pens and sticky notepads, along with drug samples — can lead doctors to prescribe the more expensive brand names when cheaper generic drugs would be as effective.
The interest in legislation to register or limit the food, gifts and money that drug and device makers lavish on doctors stems from growing concerns that these benefits lead doctors to prescribe more, and more expensive, drugs and devices, raising the costs of health care and changing care to patients.
