Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial

To the Editor and Authors Pimlott et al.:

“The lack of diagnostic data on the prescription claims in our study made it impossible to evaluate the appropriateness of an individual prescription.” This statement is a key and major flaw to the entire study. The prescribing may or may not have been rational or optimal. Efforts to ‘change prescribing practices' without reference to the diagnosis of the patient seems anathema to sensible practice or research.

Benzodiazepines have beneficial effects and problematic side effects. To the extent the physicians were prescribing with attention to both there is little reason to change the patterns. However, interventions that are inattentive to the final consequence are unreasonable regardless of the population. As such they are reminders of the endless ‘war on drugs’ that permeates US prescribing practices for opioids or benzodiazepines. Do you not recall the US congressional hearings on the 'horrors of Valium' several decades ago? The only consequence was a shift to newer benzodiazepines which may or may not have had clinical advantage and about which much less was known.

Again, prevention of problematic effects is desirable. Prevention of rational prescribing is not.

Sincerely,

John Grabowski PhD Professor, Psychiatry and Behavioral Sciences Director, Substance Abuse Research Center University of Texas Health Science Center-Houston