[Pharmwaste] Free antibiotics may have high cost later
dldebiasi at deq.virginia.gov
Thu Mar 5 12:29:08 EST 2009
Free antibiotics may have high cost later
Stores offer promos, but experts caution about misuse and drug
By JoNel Aleccia
updated 8:42 a.m. ET, Thurs., March. 5, 2009
Offering free antibiotics to cash-strapped customers may have seemed
like a good idea this dire winter, but supermarket chains are fielding a
backlash from health experts who say the promotions may do more harm
Five large retailers have received letters from the federal Centers for
Disease Control and Prevention and the Infectious Diseases Society of
America cautioning that giving away antibiotics contributes to misuse of
medication and the rise of increasingly drug-resistant bugs.
"We were a little alarmed, especially when they suggested they'd be
doing it during cold and flu season," said Dr. Lauri Hicks, medical
director of the CDC's program on appropriate antibiotic use.
"We know that antibiotics aren't effective for cold and flu. We don't
want to perpetuate the idea that they are."
But the stores, which include Wegmans, ShopRite, Stop and Shop and Giant
Food, contend they're only filling valid prescriptions written by
doctors - and trying to save shoppers a little money in the process.
"We feel like it's a way to help our customers out during tough economic
times," said Jamie Miller, a spokesman for Giant Food, a 182-store chain
based in Landover, Md.
However, offering free antibiotics likely will prompt more patients to
ask their doctors for the drugs, experts said. Repeated research shows
that doctors often prescribe antibiotics just because a patient asks. A
study published last fall in the British Medical Journal showed that
some doctors use antibiotics as placebos for patients who insist on
"It's much easier to give someone an antibiotic than it is to explain to
someone why they don't need it," said Dr. Ed Septimus, an internist who
helped write the letters sent by the IDSA.
Giant Food is one of several retailers that launched free-drug giveaways
this winter, providing up to two weeks of the most frequently prescribed
antibiotics, including amoxicillin, erythromycin, ciprofloxacin and
penicillin. The offer is available to anyone with a prescription whether
they have health insurance or not.
A typical round of antibiotics costs $10 to $20, though many stores have
started offering $4 generic prescriptions.
Most of the stores planned to continue offering the drugs through the
end of this month, if not longer. Some grocery chains, such as Meijer
Inc. of Grand Rapids, Mich., and Publix Super Markets Inc. of Lakeland,
Fla., have offered the free meds year-round for several years.
'Well-intentioned but obviously ill-advised'
That worries many infectious disease specialists, who say they've been
fighting for years to reduce demand for the drugs.
"I was actually driving to work and saw this huge billboard that said
'Come to Wegmans for free antibiotics,'" said Ann Marie Pettis, director
of infection prevention at the University of Rochester Medical Center in
"Here we are all working so hard to control the use of antibiotics and
then to see something that's well-intentioned but obviously ill-advised
was surprising," she said.
Other experts contend that the stores' motives aren't completely
altruistic because they're using the free drugs as so-called "loss
leaders" to attract new customers.
"They're buying these drugs for pennies and they're getting people into
the store to buy things they can make money on," said Septimus.
If the stores really wanted want to help, they'd give away free flu
shots or free blood pressure medications, services that save shoppers
money and don't compromise their health, he added.
Even when they do need the drugs, the free programs may influence
patient demand. When Lisa Samples' husband, James, needed an antibiotic
for a bad case of bronchitis this week, the 42-year-old Dallas, Ga.,
woman asked the doctor to prescribe something from the free list at her
local Publix supermarket.
"It makes a difference right now, definitely, especially because we're
both not working," said Samples, who called the free drugs "a great
"I ended up going in and spending money," she said, noting that she
picked up eggs, milk, bread and lunchmeat.
Stores say they aren't prescription police
But the stores counter that the problem isn't that they're providing
free drugs, it's that doctors aren't prescribing them correctly, said
Frank Guglielmi, a spokesman for Meijer Inc., which operates 180 stores
in five states.
"The premise that we're responsible for policing prescriptions? That's
not what a pharmacy does," he said.
Whatever the source, however, health experts say easy access to
antibiotics is at the core of the growing problem of drug resistance.
Overuse of the drugs has allowed many bacteria to become increasingly
immune to the medications. That has fueled the rise of potentially
deadly superbugs such as MRSA or methicillin-resistant Staphylococcus
aureus, and C. diff, or Clostridium difficile.
C. diff, a severe intestinal illness that can lead to removal of the
colon or even death, often is sparked by recent use of antibiotics such
as ciprofloxacin, which is on the free lists.
Even when the problem isn't life-threatening, antibiotics can cause
harm. About 142,000 emergency department visits each year are tied to
antibiotic use, mostly allergic reactions, according to a recent study
in the journal Clinical Infectious Diseases.
"The fact is that antibiotics are not harmless," said Hicks, the CDC
specialist. "There's a perception that antibiotics are like candy."
She has urged stores to help raise awareness of proper antibiotic use by
providing information from the CDC's program, "Get Smart: Know When
That's why the agency tried to be diplomatic in the recent letters. "We
were concerned if we took a very aggressive approach with them, we would
lose any opportunity to get our message out there," said Hicks.
Stores surprised by strong reaction
That has worked with Wegmans, which may soon stock the CDC literature
along with the free drugs. Spokeswoman Jo Natale said the company was
surprised at the strong reaction from many health experts after the
program began. Some doctors called the company to protest the program.
"Did we go to public health officials and ask their advice? We did not,"
she said. "We should have had those conversations."
As it was, the retailer acknowledged health officials' concerns by
sending out tips to their customers on the proper use of antibiotics.
"Without meaning to," Natale said, "we did initiate a dialogue about
this very topic."
(c) 2009 msnbc.com Reprints
Deborah L. DeBiasi
Email: dldebiasi at deq.virginia.gov
WEB site address: www.deq.virginia.gov
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