A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

A prescription for death: Does doctors' illegible handwriting kill more than 7,000 patients annually? Is drinking alcohol a good cold cure?

November 30, 2007

Dear Cecil:

I recently heard a statistic on a radio talk show that in the U.S. alone there are over 7,000 deaths per year due to mistakes made by pharmacists because of the physicians' illegible handwriting on the prescription! Can this be true?

You'd almost hope so, Don, given that Time magazine saw fit to lead with it: "Doctors' sloppy handwriting," a January 2007 article begins, "kills more than 7,000 people annually." (I'd bet Darvon to doughnuts that's where the radio personality you heard saw it.) But the author may have had some difficulty deciphering his own notes: the actual stat alluded to - apparently from a 1998 Lancet paper via subsequent reports by the Institute of Medicine - is that each year 7,000 U.S. deaths result from all medication-related errors of any sort, inside and outside hospitals, and not just those tied to poor penmanship.

Which, of course, is still plenty to ponder while popping your next pill, and there's more where that came from. Scanning an IOM report from last year we learn:

  • About 1,400 prescribing errors are made per every 1,000 hospital admissions (remember that a typical inpatient may receive 20-plus doses of meds daily), more than 100 of them serious.
  • Two leading studies of medication errors made by nursing home staff didn't even include the most common mistake, administering drugs at the wrong time, and still found between 12 and 15 errors per 100 doses.
  • A 2003 study reported that nearly one in eight prescriptions phoned in to pharmacies contain misinformation, while estimates of pharmacists' error rate in dispensing drugs range from under 2 percent up to nearly 24 percent. Even using the lowest figure, that's more than 50 million mistakes a year nationwide.

(Anecdotal evidence break: My assistant Una says she gets the same six prescriptions filled monthly and guesses the pharmacy commits one serious screwup every other month - an 8 percent error rate on refills, for God's sake.)

But whatever the incidence of medication errors (and more figures got thrown around last week following the heparin overdose reportedly given to Dennis Quaid's infant twins), it's hard to pin down the role of handwriting. One small-scale study from 2002 found that 15 percent of handwritten medical records at a Spanish hospital were unclear due to legibility problems (the surgeons' notes were the worst), a 2001 British paper reported that more than 10 percent of handwritten prescriptions contained errors, and U.S. studies have found that 20 percent of prescriptions or more were unreadable or readable only with effort. Some experts estimate that maybe a quarter of medication errors are due to illegibility. But time-honored notions aside, comparative studies disagree over whether those who've earned an MD do tend to have worse handwriting than those who haven't. Maybe it only seems that way when that little scrap of paper could determine whether you live or die.

Recently I was suffering from a particularly nasty head cold or flu - runny nose, headache, sore throat, etc. After about my third day of bed rest and lots of vitamin C, the tedium of convalescence got to me. So while watching movies, I drank about half a liter of whiskey mixed with Coca-Cola. Amazingly, the next day I was completely well. I know alcohol kills pretty much anything on contact, but is the concentration in your bloodstream sufficient to knock out germs and viruses? Should I start submitting bar tabs to my health insurer? - Self-Medicating in Muskogee

I don't know what plan you're on; mine won't pick up the check for a triple bypass without a doctor's affidavit confirming the surgery was absolutely necessary. Anyway: rubbing alcohol used as a disinfectant contains about 70 percent alcohol, whereas a blood alcohol concentration of only 0.4 percent is typically associated with unconsciousness and death. If you tried to drink your way up to a bactericidal BAC, the alcohol would be way too busy killing brain cells to have much time for the germs.

It's almost certainly a coincidence, therefore, that you got better following your experiment with bender therapy. That said, while there's no evidence that alcohol will help fight colds that've already been caught, moderate drinking may keep colds away. A Carnegie Mellon study from 1993 found that smokers were at greater risk of coming down with something no matter their drinking habits, but nonsmokers' resistance to colds increased with consumption of alcohol (up to three or four drinks daily). And after surveying almost 4,300 Spanish university employees, researchers reported that those who drank 14 or more glasses of wine a week were only 56 percent as likely to catch a bug. The team speculated that antioxidant and anti-inflammatory properties of wine may have played a role; beer and spirits drinkers saw no health benefits. So for maximum future cold prevention, you may want to self-medicate less like a lead guitarist and more like a second violinist.

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