Cacoefnes Praescribendi

When Britain's National Health Service began offering medical care and prescriptions with no direct charge to the patient, doomsayers prophesied that doctors' offices would be filled with hypochondriacs demanding chits for tonics. As it turned out, there was less of this trouble than had been feared, and what there was of it has been gradually dying out. But few critics foresaw that on single prescriptions, which now cost patients only 28-c-, a lunatic fringe of doctors might prescribe whatever a patient asked for, in unlimited quantities and at fantastic cost to Her Majesty's Treasury.

Ordered by the Ministry of Health to sleuth out cases of cacoethes praescri-bendi (a mania for prescribing), Dr. James E. Struthers collected and reported some shockers to the British Medical Association:

> One Lancashire family got 800 "Purple Hearts" (pep pills) a day.

> On a single prescription, one doctor ordered $1,260 worth of an antituberculosis drug (a 2 1/2-year supply).

> Enough laxative for 100 people was prescribed every week for one woman.

>Some patients got 24 to 36 medicated aerosols a day, at a cost to the government of $36 to $53; others got $280 to $420 worth of oxygen a week.

> One doctor wrote a monthly prescription for $1,400 worth of a patented enzyme drug.

Most of Britain's 22,000 N.H.S. doctors are, overall, low-cost prescribers. The expensive exceptions number only 30 to 40. And they do not get away with it for long. When a doctor seems to be regularly overprescribing, he gets two warnings. Finally, a committee of the doctor's own colleagues may suspend his license. Ten years ago, there were ten suspensions a year. Last year there were none. The overprescribers, Dr. Struthers believes, are getting the word.

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