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When Evidence Says No, But Doctors Say Yes

By ProPublica  
   February 22, 2017

"Yes, we can move a number, but that doesn't necessarily translate to better outcomes," says John Mandrola, a cardiac electrophysiologist in Louisville who advocates for healthy lifestyle changes. It's tough, he says, "when patients take a pill, see their numbers improve, and think their health is improved."

The overall picture of beta-blockers is complex. For example, some beta-blockers have been shown clearly to reduce the chance of a stroke or heart attack in patients with heart failure. But the latest review of beta-blockers from the Cochrane Collaboration—an independent, international group of researchers that attempts to synthesize the best available research—reported that they "are not recommended as first line treatment for hypertension as compared to placebo due to their modest effect on stroke and no significant reduction in mortality or coronary heart disease."

Researchers writing in Lancet questioned the use of atenolol as a comparison standard for other drugs and added that "stroke was also more frequent with atenolol treatment" compared with other therapies. Still, according to a 2012 study in the Journal of the American Medical Association, more than 33.8 million prescriptions of atenolol were written at a retail cost of more than $260 million. There is some evidence that atenolol might reduce the risk of stroke in young patients, but there is also evidence that it increases the risk of stroke in older patients—and it is older patients who are getting it en masse. According to ProPublica's Medicare prescription database, in 2014, atenolol was prescribed to more than 2.6 million Medicare beneficiaries, ranking it the 31st most prescribed drug out of 3,362 drugs. One doctor, Chinh Huynh, a family practitioner in Westminster, California, wrote more than 1,100 atenolol prescriptions in 2014 for patients over 65, making him one of the most prolific prescribers in the country. Reached at his office, Huynh said atenolol is "very common for hypertension; it's not just me." When asked why he continues to prescribe atenolol so frequently in light of the randomized, controlled trials that showed its ineffectiveness, Huynh said, "I read a lot of medical magazines, but I didn't see that." Huynh added that his "patients are doing fine with it" and asked that any relevant journal articles be faxed to him.

ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.


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