• Geographic differences in antibiotic use

    Interesting piece in USA Today:

    West Virginia had the highest antibiotic use per capita from 1999 to 2007, the period evaluated by scientists from Extending the Cure, a project of the nonprofit Center for Disease Dynamics, Economics & Policy. It is funded by the Robert Wood Johnson Foundation.

    From 2006 to 2007, West Virginians got 1,222 prescriptions per 1,000 people. That’s more than twice the antibiotic use of Alaska, the lowest, with 546 prescriptions per 1,000 people.

    “It’s actually quite a significant variation in prescribing patterns,” says Ramanan Laxminarayan, director of Extending the Cure.

    Much of the excess prescribing is for respiratory infections caused by viruses, against which antibiotics are useless, he says. Misuse of antibiotics for treating viral infections can lead to bacteria that are resistant to them.

    The article goes on to focus on the overuse of antibiotics, and the problems this can cause with respect to resistance. While that’s important, I’m interested in this as an example of what’s wrong with the practice of medicine in America. Does anyone believe there’s really twice the infection in West Virginia as in Alaska? Does anyone believe that the outcomes in Alaska are half that of  West Virginia?

    If not, then what’s justifying using twice as much care? What’s justifying the cost difference?

    More importantly, does anyone think that this is the only example of variations in use that’s completely unjustified? This is a perfect example of a situation where we could likely save money without impacting outcomes.

    • Cue one of the commenters incorrectly ascribing this finding to physician compensation.

    • Suppose someone did propose linking (Medicare) payment for a treatment to actual evidence that the treatment is beneficial. How long do you think we would have to wait until Sarah Palin resuscitated the “death panels” meme or Michele Bachmann found some woman whose daughter suffered gravely because she did or didn’t have access to antibiotics? An hour?

      C’mon man! That’s what happens any time a new variety of unwarranted treatment variation is revealed. Oh, by the way, specialist MDs in the US are wildly overpaid, but I doubt that has anything to do with excessive antibiotic Rx patterns.

    • I haven’t looked at this but I wonder if it’s controlled for access to healthcare or disease prevalence.