IRA FLATOW, host:
For the rest of the hour, a look at prescription drugs and death. When news of actor Heath Ledger's death broke, it was widely reported that he died from an accidental drug overdose, but not of illegal street drugs. The New York medical examiner's office ruled that Ledger had died accidentally from, quote, "the abuse of prescription medication." Among other things, Ledger had prescriptions for the pain medication oxycodone as well as sleeping pills and two anti-anxiety medications. Ledger's case is really not an isolated incident. New work published in this week's Archives of Internal Medicine say that in the past 20 years, deaths caused by prescription medication errors have skyrocketed.
Case in point, deaths outside of a hospital or clinical setting where people take their prescriptions incorrectly, or we mix them with other drugs or alcohol, these kinds of deaths have shot up 3000 percent, that is 30 times if you take off those zeros. So what is going on? Joining me now to talk about this is one of the researchers from this project, Dr. David Phillips, professor of sociology, UC San Diego. Welcome to the program.
Dr. DAVID PHILLIPS (Sociology Professor, University of California - San Diego): Well, thank you.
FLATOW: Was this shocking to you when you did the research?
Dr. PHILLIPS: Well, I had done earlier research on approximately this topic in The Lancet. And I had found that deaths from medication errors were increasing steeply, but I didn't know where they were increasing most steeply. This 3000 percent increase that you mentioned was new to us. And what was also new to us was that the total number of years of potential life lost from medication errors now exceeds the number of years of life lost from any other kind of accident except for motor vehicle accidents. So if you take all kinds of accidents from firearms, falls, fire and flames, drowning and non-medication poisonings combined, they don't account for as many years of potential life lost as do medication errors.
Dr. PHILLIPS: Accidental medication errors.
FLATOW: Are these accidents from people who don't know they're taking too many together or they just don't listen to their physicians' advice correctly or how can you qualify them?
Dr. PHILLIPS: Well, we know these are not officially acknowledged medication errors, but we don't know what kind of error they are. We don't know how much in this mix is arising from misuse or from carelessness or from abuse. That will have to be evaluated in future research.
FLATOW: And what is your baseline for figuring this out?
Dr. PHILLIPS: Well, this study is based on 50 million U.S. death certificates over the last 20 years, and particularly on 200,000 medication error deaths. And the baseline is what was happening in 1983, and we tracked what was happening since 1983 up through 2004, which was the most recent data available at the time of the study.
FLATOW: And if you do a graph, could you actually see a rising line on that graph?
Dr. PHILLIPS: Oh, yes. It's very, very, very striking. All kinds of control diseases. Any other kind of accident, homicide, suicide, anything involving poisoning other than medication errors. Those things are either going down over this time period or going up very little. So, the whole story could be told just with the graph. So, I've never seen in other kinds of epidemiological research a line going up this steeply.
FLATOW: Now, I understand you had four different kinds of medication errors depending on the circumstances involved. Correct?
Dr. PHILLIPS: Yes. We divided up medication errors into, most fundamentally, into those that are taking place away from medical supervision, in particular at home. And then we also divided them up according to whether or not alcohol and/or street drugs were taken at the same - helped to contribute to the death along with the medication. And if you just look at domestic medication error deaths, those are going up over this time period about 770 percent, that's actually the death rate has gone up about 770 percent. If within those domestic medication error deaths you concentrate on ones which involve not only medications but also alcohol or street drugs, those have gone up not 770 percent but more than 3000 percent.
Dr. PHILLIPS: And then if you take on the other hand medication error deaths that are occurring not in the home and not involving alcohol or street drugs, those have gone up only five percent.
FLATOW: Such as hospitals - places in hospitals. Like that?
Dr. PHILLIPS: Yes. That's right. So there's a tremendous difference between the increase depending on where it's happening and whether or not alcohol is involved.
FLATOW: Why are we seeing so many more deaths from people taking drugs at home? Weren't these - be some things they'd be taking in the hospital in past times?
Dr. PHILLIPS: Yes. Over the past 20 years, the length of stay in the hospital has gone down tremendously because people have been trying to save money. And in addition, over the past 20 or even 50 years, there've been more and more medicines available for more and more diseases. So, the consequence of this is that nowadays, the patient is much more likely to be taking the medicine away from medical supervision. And what's happened is that there's been this I think naive assumption that the patient can handle being part of the quality control team, and I think this is something that can no longer be assumed based upon our findings.
FLATOW: Was there any one age group that stood out among the rest?
Dr. PHILLIPS: Yes. Rather to our surprise we find that the increase is most striking for people under age 60. Almost all previous research on medication errors have been for people over 60 because those are most of the people taking the medicine. And there is a small increase for people over 60 in the number of deaths from medication error death. But the largest increase by far is for people under 60. Children zero to nine are not showing any increase in medication error death. But every other age group is, and particularly the age group 40 to 59.
FLATOW: And we suspect that why? Would you...
Dr. PHILLIPS: Well, I think that they're particularly likely to be taking medicine at home and particularly likely to take medicine in conjunction with alcohol or street drugs.
FLATOW: Is there any practical advice you can give us? We all have all this medicine in our cabinets. How do we know?
Dr. PHILLIPS: Yes. I think there's two kinds of implications. I think there's policy implications to the study and I think there's also research implications. I think that clinical staff needs to increase their efforts to educate patients on the potential dangers involved of taking medicines and particularly of mixing medicines with alcohol. And I think that beyond that, clinical staff need not only to educate but also to monitor the behavior of the patient to see whether the patient indeed is capable of monitoring the safety of his own medications. And then, if it is found that the patient is not able to take this role on his shoulders, then it may be necessary for clinical staff to supplement that role.
And up until now, there's been this rather convenient assumption which says OK, you're leaving the hospital, take this medicine. It may be a complex set of medicines on a complex schedule, but we're just going to assume that you can manage. And I think that, that's a - our data suggest that that's not a sensible assumption. The increase in death from medication errors is not only very steep but it's increasingly steep over the years, it's going up faster and faster.
So now, the number of people dying from medication errors is about the same as the number of people dying from homicide in this society. And in a year or two it will outstrip that. The only kind of accidental death that is more important from a public health point of view in the society at the moment is motor vehicle accidents, and they're going down over time, whereas these deaths are going up.
FLATOW: Wow. We're talking with David Phillips on Talk of the Nation: Science Friday from NPR News about death from medications. Let me see if I can get a quick phone call in, Pax (ph) in Roanoke. Hi, welcome. Quickly.
PAX (Caller): Yes. I was just wondering if the data was normalized in any way as to like maybe the population or the increasing population that are actually taking prescriptions.
Dr. PHILLIPS: Yes, of course. That's an excellent question. What we're talking about here is an increase in the death rate from medications which means to say, you're correcting for the changing size in the population. And in addition to that, we did look to see what's happening to the number of prescriptions that are given each year. And that has indeed gone up, but it's gone up maybe 70 or 80 percent over that time period. It's gone up nowhere near the 3000 percent that we've been talking about.
FLATOW: Can you give us an idea of what drugs are showing the most deaths?
Dr. PHILLIPS. No. I think that's something that needs to be looked at in future research. Some information on individual kinds of medication errors is available on the death certificate, but we didn't do that in this study.
FLATOW: So you couldn't say it's depression medication or antibiotics or something like that.
Dr. PHILLIPS: Right. We will be able to say that in the next study, but not in the current one.
FLATOW: And so, tell us about that next study.
Dr. PHILLIPS: Well, there are many different kinds of studies that can now and should now be done, I think. I think that one style is to do what you've just been talking about, is to see which kinds of medicines are most closely involved with this increase or show the steepest increase. Another kind of study, which would not involve death certificates as we were using but would involve an examination, say, of hospital records or an examination of some other kind of smaller sample, would examine not what we looked at, which was fatal medication errors, but to look at non-fatal medication errors. We were able to look only at fatal errors because we're looking at death certificate data.
Dr. PHILLIPS: And this may just be the tip of the iceberg. You know, it may be that serious medication errors which don't result in death are also showing this effect, but we can't tell that. And I think future research should see if that's true.
FLATOW: One last question. And when we go into hospitals, we're always fearful that our doctor is going to prescribe the wrong medications or we're getting someone else's medications, and we might die from that. You seem to be saying you have a better chance of dying outside of the hospital now.
Dr. PHILLIPS: Well, it's not yet - better is a strange word, but let's say the proportion of medication error deaths that are occurring outside the hospital is going up very steeply. And it's not yet the majority of medication error deaths. But I would say that one moral of the story is that you need to recognize that clinical staff can play a major role in causing these medication errors but also now for the first time, we see that the patient can also play a major role. And therefore, research on this topic needs to be broadened much more than was previously the case.
FLATOW: Dr. Phillips, thank you for taking time to be with us today.
Dr. PHILLIPS: Sure. My pleasure.
FLATOW: You're welcome. Dr. David Phillips, professor of sociology at the University of California at San Diego.
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